
i 





Class ~K>"6 i +S- 
Copyright N° 

COPYRIGHT DEPOSIT. 




This photograph of Harvey, the discoverer of the circulation of the blood, is a reduced 
copy taken from one of a collection of original engravings and 
medical manuscripts dated 1777. 



DIAGNOSIS 
BY MEANS OF 
THE BLOOD 



ILLUSTRATED BY 154 PHOTO- 
MICROGRAPHS OF SPECIMENS 
OF BLOOD, AS OBSERVED IN 
GENERAL PR ACTICE, SHOWING 
PRODUCTS THAT ARE FOUND 
IN DEFINITE DISEASES 




Robert Lincoln Watkins, M.D. 



Wi 7 V 

1902 



THE PHYSICIANS BOOK PUBLISHING CO. 

NEW YORK AND LONDON 



THE LIHAdV mf 

CONGRESS, 
Two Cornea Receive* 

APR. 9 190? 

COPVIMiMT ENTHV 

CLASS CUXXe. No. 

% is, i 

OOPY B. 



COPYRIGHT, 1902 
BY 

ROBERT LINCOLN W ATKINS, M.D. 



ENTERED AT STATIONERS' HALL, 
LONDON, ENGLAND. 



DEDICATION. 
To my father, Gardner Augus- 
tus Watkins, an inventive genius 
of the class which never recog- 
nizes defeat. It was he who, years 
ago, put medical books into my 
hands, and said: " Go ahead! " 



PUBLISHER'S NOTICE. 



A once prospective publisher desired the author to suffix 
various titles and societies to which he belongs to his 
name. 

He refused, however, for he desires the book to sell only on 
its merits. 



PREFACE. 



This work deals with the examination of fresh or live blood, 
as American investigators have found it. 

It is not intended for the laboratory worker, but for the gen- 
eral practitioner. 

In this work the blood is studied as one of the vital organs 
of the body. 

I draw no conclusions, but give the facts as I have found 
them. In making the examinations described the only ap- 
paratus required is an ordinary microscope magnifying 400 
diameters. 

The cases have of necessity been taken from the writer's 
own practice, and if the work shall be the means of aiding the 
physician and promoting a wider interest in all forms of blood 
examination, the author will feel well repaid. 

R. L. W ATKINS, M.D. 

20 West Thirty-fourth Stkeet, 

New York, April 1, 1902 



C N T E jS t T S 



Frontispiece, .......... 4 

Title, . . . . . . . . . . 5 

Dedication, . . . . . . . . . 7 

Publisher's Notice, ......... 9 

Preface, .......... \\ 

A Word in Regard to the Illustrations, . . . . .15 

Introduction, . . . . . . . . . .17 

Method of Procedure for a Feesh Blood Examination, . . .25 

How to Get the Blood, . . . . . . . .27 

Lances, ........... 29 

Moving Blood Cells, with Illustrations, .... 35-42 

Dry Blood, ... . . . 43-45 

Illustrative Cases, . . . . . . . 47-51 

Healthy Blood (Illustrated), ...... 53-62 

Unhealthy Blood (Illustrated), ...... 63-70 

Tuberculosis, . . . . .. . . . . 71-82 

Tuberculous Fibrin, ...... 83-88 

Further Discussion, ....... 89-95 

Pulmonary Tuberculosis Cases, ..... 97-103 

Inherited Tuberculosis, . . . . . 104 

Recovery from Tuberculosis, ..... 105 

Ulcer of the Stomach, ...... 106 

Illustrations of the Above Cases, Including a Lupus Case, 107-131 

Septicemia (Illustrated), ....... 133-139 

Blood in Rheumatism (Illustrated), ..... 141-163 

Crystals in Blood (Illustrated), ...... 165-178 

Embolus (Illustrated), ....... 179-216 

Paralysis, . . . . . . . . 188 

Cow's Blood, ........ 189 

Cardiac Diseases (Illustrated), ..... 203 

13 



14 CONTENTS. 

PA GE 

Meningitis, ... . . . . . . . 217-223 

McKinley's Case (Illustrated), ...... 225-234 

Syphilis (Illustrated), ....... 235-254 

Preamble, . . ... . . . 23$ 

Germ of Syphilis, ....... 243 

Remarks, ........ 247 

Testimony, ........ 250 

Illustrations, ........ 251 

Malaria, . . . ... . . . . 255-272 

Laveran's Letter, ....... 260 

Dr. Hall's Letter, ....... 261 

Illustrations, ........ 263 

White Blood Cells, ....... 273-300 

Leucocytes (Illustrated), ...... 277-282 

Leucocytosis, ........ 283 

Estimation of Leucocytosis (Illustrated), . . . 286-299 

Furunculosis, ........ 301-304 

Illustrations, ........ 305 

Neurosis, ........ 307-310 

Illustrations, . . . . . . . . 311 

Poikilocytes, ......... 315-318 

Illustrations, . . . . . . . . 319 

Vitality, . . . . . ... . . 321-326 

Illustrations, ........ 327 

Foreign Matter, ........ 329-334 

Illustrations, . . . . . . . . 335 

A Peculiar Case, ........ 341 

Miscellaneous, ........ 343-348 

Illustrations, . . . . . . . 349 

Micro-Motoscope. ........ 365 

Anti-Toxine, ......... 369 

Illustrations, ........ 373 

Last Remarks, ........ 375 



A WORD IN REGARD TO THE 
ILLUSTRATIONS. 



These pictures are taken from a collection gathered from an 
experience of many years. In getting the photograph the pa- 
tient was invariably present. They are not intended to be 
specimens of art for the photographic critic. If they were I 
should have taken them with a photographic objective — a 
special lens used in all laboratories for taking photo-micro- 
graphs. 

No photographic lens is used in these illustrations. The 
lenses employed are — when not otherwise mentioned — the or- 
dinary D (1-6) and E (1-9) Zeiss or the corresponding Leitz ob- 
jectives. 

The time of exposure varies from 30 seconds to 1-200 of a 
second. They, therefore, probably show details that have not 
heretofore been recorded. 

Many writers, when publishing photographs illustrating 
their work, cut out the unfocused part of the picture and pub- 
lish the best. I have reproduced the whole field as exposed. 



INTRODUCTION. 



The first question a person asks when he gets sick is: 
'•What is the matter?" 

The first thing that a physician asks when he is a little puz- 
zled is: "How am I going to find out?" It is with the inten- 
tion of being of service to both the patient and doctor that this 
book has been written. 

Many physicians hare said to me: "Books and articles writ- 
ten upon new subjects are so full of technicalities and elab- 
orate processes that can be performed only in the laboratory 
that they are of little interest and of much less value to us.'' 

To overcome this difficulty I have made this picture book so 
that it will be of service even to the physician of little or no 
experience in microscopy. I presented an outline of this work 
and its importance to the American Medical Association at 
Atlantic City, June 8, 1900. 

While a great many of the photographs are taken from ad- 
vanced cases, others are taken during the early stages of a 
disease. This was done to make the subject plain; since a 
more advanced stage of disease is more perceptible to the stu- 
dent and thus more easily diagnosed. 

It has been said*: "Is it not true of disease that one-half the 
patients seen by the physician are seen far too late? Had those 
patients been seen earlier, injury could have been prevent ed- 
it is a truism that gout exists in the patient's system long be- 
fore it causes a twinge of pain. He is the greatest discoverer 
who finds the pre-symptom or symptom of the symptom. 

"There are a hundred known intimations or auras of on- 
coming disease, but there are a thousand undiscovered ones, 
pre-symptoms, advance scouts and forerunners to be learned, 
when the slight and unconscious departures from a normality 
are studied by examinations of the supposably well." 

It may be that the author refers in his first statement, or 



* See Bibliography. 



17 



is 



INTRODUCTION. 



rather in the first two statements, to slight subjective or ob- 
jective premonitory symptoms. But in regard to gout he cer- 
tainly does not; or if he does, we feel warranted in stating 
that there are crystals and other conditions in the blood that 
show this disease years before symptoms manifest themselves 
elsewhere. And those who peruse these pages will perceive 
that not only are the above statements true, but that it is 
also true that in the blood lies more disease as well as more 
premonitory symptoms of disease than can be found in any 
other part of the body. 

The quotation goes on: "Pathogenesis, not therapeutics, is 
the ultimate study of all medicine. And all pathogenesis is 
by no means running bugs to their holes. The greater num- 
ber of life- wasting diseases are not bacterial in origin; and 
even the growth of the bacterial diseases depends on the soil 
in which they are sown." 

On the following pages it will be found that in the fresh 
blood lies this pathology — these premonitory symptoms. The 
"symptom of the symptom" can be seen in the examination 
of fresh blood. It will be seen that the germs are, as Dr. 
Gould says, not the only cause of disease; for the fresh blood 
here is shown to contain this "soil" — of one at least of the 
most prevalent diseases with which mankind is afflicted. 

These remarks are the foundation of this teaching and the 
theory is borne out by the results shown in this work. We 
also want to emphasize the fact that an examination of 
the blood is the surest way of diagnosing the disease when 
it is well seated. This logically follows not only from the 
previous remarks, but it is very evident that a disease cannot 
be chronic or advanced (as the term chronic signifies) with- 
out going through the various stages from inception to its 
most severe form when it is seen much more plainly in the 
blood. Therefore the blood reveals disease in not only its 
incipiency but in its advanced condition. 

With such a wide range of conditions and diseases discern- 
ible by the hematologist, when allied with experience as a 
general practitioner, none should be better able in these days 



INTRODUCTION. 



19 



to make a diagnosis than he. This being true it is much 
easier to give a prognosis and say whether the case is amen- 
able to treatment or not. 

More than twenty years ago a prominent physician of this 
city took a microscopist to one of our large hospitals to ex- 
amine the blood of some cases of syphilis, a disease the direct 
source of which has never been determined. The object was to 
see if a difference between those who had the disease and 
those who had not could actually be determined. The exami- 
nations were made with no comment. Time went on and on, 
until ten years had passed — then casually, at a chance meet- 
ing of the two men, the hospital doctor told the microscopist 
that his diagnosis at that time was correct. 

Is it right to wait ten years before acknowledging the truth 
of a new discovery, especially to one who has spent years of 
hard-earned money and labor in a cause we all love to call hu- 
manitarian? This practice seems to be in all walks of life, 
but should it be so with ours? 

I was also told by the physician referred to that the micro- 
scope was the cause of more mistakes than any other instru- 
ment of diagnosis. Such a statement is not worthy to be con- 
sidered. Were it not for the fact that such hasty assertions 
are regretted in later years, I would not quote this, for at the 
time those who make them forget that a novice cannot use a 
microscope as a means of diagnosis. They forget that there 
are unskilled gynecologists and surgeons and physical diag- 
nosticians. So there are unskilled microscopists and there 
are others who use the wrong method of examination. 

Wagner, the greatest modern musician, was thirty years a 
composer before he was acknowledged as pre-eminent. And 
why was it? Because his music was different from others; he 
employed different methods to produce his effects. He 
studied philosophy, painting, as well as music and the sciences. 
He then wove his knowledge into each piece of his music, 
so that the theme of his operas when reproduced recalled to 
the educated ear the figure, the man or the scene which the 
master had intended. 



20 



INTRODUCTION. 



And so this science of the blood is a different branch of 
medicine. It is a science that looks at medicine from a new 
point of view. It is intended that all means known to science 
should be brought as aids to diagnosis. But still there are 
those who have made it a specialty, like the gynecologist or 
the surgeon. There have been few Simses and Thomases in 
the past. So there are microscopists of different grades to- 
day. Some have the arts so mixed in them that they perceive 
with little trouble and by a simple examination some symp- 
toms at which others have to spend hours, just as Paganini 
acquired his skill in playing the violin by a daily practice 
sometimes twelve hours long. So there are microscopists who 
labor for hours on one point. The others may be considered 
only dabblers at it. But the microscopists who examine the 
fresh blood specimens are those who make the fewest mis- 
takes in diagnosis. This must be true, for they see the blood 
nearly in its natural condition. Have the patient present, 
doctor; examine no dried blood specimen. 

Probably the first man to study the blood microscopically 
was J ohn Hunter. It was certainly in his day that it was best 
known macroscopic-ally ; that is, as it flowed from a wound and 
was collected and studied with the naked eye. Physicians in 
those days could tell more or less about disease by the gross 
appearance of the blood when thus observed. This was more 
than a hundred years ago. Blood-letting has died out, and 
with it died the examination of the blood for disease. In the 
forties Virchow discovered the condition he called leukemia, 
a disease which is considered fatal, and which is characterized 
by the great abundance in the blood of the white cells — hence 
the name. 

In 1846 Otto Funke, of Leipzig, published a book in which 
he showed fibrin filaments in the blood. The spirochaetae of 
Obermier, a filamentous parasite, was found in the blood of 
malarial patients somewhere about this time. Outside of this, 
little or nothing was known to be in the blood of a diseased 
person. It was not studied by the profession at large at all. 
About 1880, the idea came to the German physicians that 



INTRODUCTION. 



evidence of disease could or should be found in the blood. 
About this time germs were beginning to take a prominent 
place in pathology. In locating them, and in differentiating 
one variety from another, stains were being used. It was 
natural, therefore, that they should be used in blood study; 
and this, I suppose, is the reason why some physicians should 
investigate by means of stains, leaving the old method, which 
was the better and more natural laid down by Virchow, and 
using the unnatural method of killing the blood. 

Ehrlich probably was the original pioneer in this work, and 
set rolling the ball which is still going to-day, for the staining 
of blood is done for purposes of examination in all hospitals 
and laboratories. 

My work, however, lies along different lines. I use no 
stains, but examine the live blood fresh, as soon as it is drawn, 
in order to note the changes that take place. The fibrin in 
the fresh blood is a normal product, and different states of it 
arc pathological. There are diseases in which there is little 
fibrin. Very often bleeders have so little that it is thought 
they have no fibrin in the blood. 

But fibrin is one of the invariable constituents of normal 
blood. It is a fine, invisible net-work which circulates in the 
blood continually wherever it goes. On exposing the blood to 
the air, the fibrin oxidizes and contracts, which makes it visi- 
ble under the microscope. It is well known that if one whips 
the blood, the fibrin can be easily obtained. This has been 
taught in our physiologies for years. This whipping merely 
separates the cells and forms the fibrin into coarse strings. 
This same fibrin in its natural condition is what I refer to. It 
is one of the prettiest sights that can be seen through the mi- 
croscope, being a faint, fine crystalline appearing cobweb of 
normal fibrin filaments. It is quite a fad to count the number 
of cells and estimate the percentage of hemoglobin in the 
blood by delicate instruments. This in time will give place to 
more simple methods, and, in fact, such methods are already 
being used. As it is usually done now, it is merely secondary 
compared with other things. One who has had experience can 



22 



INTRODUCTION. 



tell with the eye if there is much variation. This will be illus- 
trated in the body of this work. Besides, what is the differ- 
ence if the white cell show 15,000 to the cubic millimeter or 
20,000, or whether the hemoglobinometer shows 80% or 85% 
of hemoglobin? Practically all will agree that it makes no 
difference, for the various physiological conditions which 
modify these proportions are too numerous to mention, to say 
nothing of inaccuracies attributable both to the observer and 
the instruments. Two observers never exactly agree. 

A large number of microcytes (small red cells), my observa- 
tions lead me to conclude, are found in people who may sim- 
ply be called neurotics. They are very characteristic when 
abundant. What is called the poikilocyte of Ehrlich is sim- 
ply a red cell out of shape and weak — it has lost its tone. 
These are very readily seen. 

From a blood standpoint, all tuberculous people have rheu- 
matism no less than the regular rheumatics, but the pain is 
more or less present. Rheumatism from this point of view is 
characterized by a thickened, adhesive condition of the red 
blood cells. Most people with paralysis, emboli and apo- 
plexies are rheumatic. 

I would like to call attention to a fact which all physicians 
know, but often forget; that is, that a sick person never has 
one disease alone — that the whole system suffers. This we 
were taught in our high-school education, and it still holds 
good. The disease physicians like to call by name is the one 
that produces the most pain or causes the deformity. These 
conditions show in the blood. Often we diagnose a certain 
disease from a blood standpoint, and it covers more ground 
than the old method of diagnosis. For example, we say from 
a blood standpoint that a man has rheumatism, yet the dis- 
ease may never have shown itself externally in other organs — 
the blood is the largest organ and is fluid besides. Rheuma- 
tism affects the entire blood. We have rheumatism of the 
joints, of the muscles, of the eyelid, of the ear, in fact, of all 
parts of the body. The blood shows them all. 

In fibrous tuberculosis, the tubercle bacillus is generally 



INTRODUCTION. 



23 



not found. The value of an examination of the blood in this 
condition cannot be overestimated. Yet, I want to emphasize 
the fact that it will take long experience to diagnose this form 
of the disease. In tuberculosis there is always found a 
granular matter in the blood-serum and often in the white 
-blood corpuscles. This I choose to call tuberculous matter, for 
it is found in all who have this disease, and there is at present 
no other appropriate name for it. It will be found in the 
tubercles that form; in fact, it is primarily their only constitu- 
ent. It is the forerunner of tuberculosis — sometimes existing 
for years. In advanced tuberculosis it exists in the blood in 
abundance. As a patient recovers it will be seen to become 
less. 

Often, as time goes on, after a discovery has become recog- 
nized, the real discoverers are ferreted out and posterity 
honors their names as former generations were incapable of 
doing. This book is not supposed to give a complete history 
of the pioneers of this work. Some examiners may have inter- 
preted things one way and I another, but I take all the respon- 
sibility of this work as presented. There may be those who 
think that credit enough is not given to some, and there cer- 
tainly will be opinions that swing the balance the other way. 
I have taken a little here and a little there; but, perhaps, the 
dross has been separated and a system prepared.* 

All I can say is: If the balance has been swung a little too 
much this way, or a little too much that way, time will adjust 
it. Be patient, for the old saying is still true: "Truth crushed 
to earth shall rise again." 



* What is meant here is that a new presentation of the subject has been prepared. It is 
not intended to convey the idea that here is an incontestable system. But the way has been 
laid for a greater work on the subject to follow by some one who may pursue it still further. 



METHOD OF PROCEDURE 

FOR A 

FRESH BLOOD EXAMINATION. 



HOW TO GET THE BLOOD.* 



To get blood for a fresh blood examination it should be 
taken from the wrist so as to obtain the capillary blood. This is 
pricked with a clean lance. The drop is squeezed out and 
placed on a glass slide, over which is put the cover glass. It 
is then put under the microscope and examined at once. A 
1-6 objective (400 diameters) is all that is required. We take 
these low powers in order to make the work practical, and 
within the reach of every physician, whether specialist or gen- 
eral practitioner, and trust each will see, before we finish, 
wherein lies its value to him. 

There are in the blood then, microscopically, the red cells, 
the white cells, the serum, and the fibrin network. In normal 
blood there are said to be about three hundred red cells** to 
one white cell. In studying, microscopically, diseases of the 
blood (and disease of the blood is disease of the body) we do 
so by noting: 

1. The appearance of the blood as a whole. 

2. The general color of the blood. 

3. The way in which the specimen moves. Important in 
tuberculosis, rheumatism and tumors. 

4. The number of red cells and their coloring matter. 

5. The number of white cells and their contents. Easily 
told by their white color and granular appearance. Note 
their ameboid movement. 

6. The arrangement of the cells. Their behavior to each 
other. How the red cells float separately and distinct. 

7. The form of the fibrin. 

8. The study of the individual cells. 

9. The germs in the serum and in the cells. 

10. Fermenting, pigment and foreign matter in the serum. 

11. Granules and crystals of various kinds. 

* See illustration on page 31. 
** Klein says there are from 600 to 1,200 red cells to one white in normal blood. This being 
true, it demonstrates still more plainly (as is pointed out in another section) how impractical it 
is to count these cells with any degree of accuracy. 

27 



LANCES. 





Two kinds of blood lances. The top one was bought by the author 

London some years ago, and is a very practical instrument. 
The two lower ones are two views of his own instrument. It will 
noted that the blade is flat instead of round. 



29 




SQUEEZING BLOOD FROM THE SMALL PUNCTURE BEFORE PLACING ON THE SLIDE. 

31 




33 



/ 



MOVING BLOOD CELLS. 



MOVING FEESH BLOOD CELLS. 



Figures 1, 2 and 3 illustrate how fresh blood should be 
moving about when placed under a microscope. Figure 1 is 
fairly healthy blood, and it illustrates how, at a glance, one 
can see certain changes. It will be noted immediately here 
that the behavior of the red cells toward each other is normal. 
At the same time it can be seen that there is an increase in 
the number of white cells; at a glance at least six white cor- 
puscles can be counted. It cannot be too deeply impressed 
upon the student that the blood must be moving when placed 
under the microscope, for there are products that disappear 
on exposure to the air, and there are other products that come 
into view. The fresher the drop the nearer it corresponds to 
that in the living being. There are products that can be 
studied at leisure, and they will be apparent. 



37 



Fig. 1. — Healthy blood moving under the microscope. 




Fis. 2. — Freshly drawn blood in motion under the microscope. 




This and the three succeeding pictures show how blood dries by standing. Taken at 
intervals of one hour each. 




3. — Dry blood. Outlines of corpuscles have disappeared. 




The two cases given on the following pages are to illustrate 
the ideal method of fresh blood examination. It is not always 
possible and convenient to follow this method, still it is a good 
one for the beginner to practice on. 



47 



ILLUSTRATIVE CASES. 



49 



ILLUSTRATIVE CASE I. 

In making a clinical examination of the fresh blood of a 
person without asking any questions, the following is the way 
the mind of the examiner runs in the given case: 

•What do you know about this man from his blood only? 
Fig. 4. 

This is the way one's mind would run in the examination: 
This man is in a bad shape; I cannot tell whether he ought to 
be in bed, or what he looks like in the face, any more than the 
ancients could judge of the character of Socrates by his looks, 
but I should think there is some disintegration taking place 
inside the man. The red cells are anemic; there may be some 
kidney weakness, while the great number of small red cells 
(microcytes) looks as if the nervous system was affected. There 
cannot be any rheumatism or consumption because of the ar- 
rangement of the cells and absence of fibrin and tuberculous 
matter. Blood poisoning might be suspected here, but no 
germs are seen. 

When he is examined we see thajg^^K stout and red-faced, 
and appears healthy. The eyes areMh He dull. 

We will ask the man a few quesr^^and see what he says. 

"What is your trouble, sir?" 

He says that his speech is getting thick, and that he is 
gradually losing his power of locomotion. His wife informs 
me that this came on once before, a year ago; that his family 
physician, Dr. Granville 0. Brown, made a diagnosis of 
Agraphia- Aphasia, a form of slow paralysis. There was then 
a partial loss of feeling in both hands. This man gradually 
and steadily got worse and died in one month. 



CASE II. 

What can you say about this man's blood without seeing 
him, simply from an examination of the photograph? Fig. 5. 

This is what is called both thick and thin blood. 

The red cells adhere to each other in small agglomerations 
like a bunch of grapes. In this rests its thickness. But there 



50 



DIAGNOSIS BY MEANS OF THE BLOOD. 



are not many red cells to the field. In this respect the blood is 
thin. This thinness also can be judged by its extreme fluidity 
when the drop is squeezed from the wrist. It will be noted 
that there is abundance of serum — the watery portion be- 
tween the cells. 

The white cells, also, are abundant, especially the ameboid 
variety. The glands are probably affected. From these facts 
you know this person has not articular rheumatism, and no 
hard fibroid tumors. 

Physicians too often forget that a disease never exists 
alone. That there are always others that accompany it. This 
should especially be borne in mind in blood examinations. 

It is the disease that is the most conspicuous, that causes 
the most pain, or that produces the deformity that people and 
doctors wish to call by name. 

The arrangement of the cells in this photograph is often 
found in consumption; hence, if this photograph contained 
tuberculous matter, and the tuberculous fibrin, one would say 
immediately that this man has tuberculosis of the lungs. 

He had an epithelioma of the face of long duration. 




Fig. 5. 
51 



HEALTHY BLOOD. 



Here are given several photographs of the healthy arrange- 
ment of the blood cells. It must be noted that this arrange- 
ment is especially called healthy in order to distinguish it 
from the abnormal adhesive condition. Figs. 6. 7, 8, 9, 10, 11. 

For example, blood may be unhealthy and still have the 
healthy arrangement of the cells, as pointed out in the pre- 
vious section; for instance, there may be germs of various 
kinds in the blood, and still the cells will be evenly dis- 
tributed, but when one has rheumatism or tuberculosis, 
especially of the fibroid variety, the cells are then adhesive 
and strung out, as in the following pictures. This always 
occurs in those who suffer from any form of rheumatism, as 
pointed out in that section. When fresh blood diagnosis is 
classified and studied as it should be, it will be found that 
there are many diseases, especially of the chronic variety, such 
as epithelioma, fibroid tumor, etc., that show this adhesive or 
rheumatic condition in a very marked degree. 



55 



Fig. 6.— 1-12 ob.j. Healthy blood. 




Fig. 8.— 1-8 obj. Healthy blood. 




Fig. 10.— 1-7 obj. Infant's blood. 




UNHEALTHY BLOOD. 



The opposite or unhealthy arrangement is shown on the 
next few pages. It is so thoroughly characteristic that com- 
ment is unnecessary, more than to say that Fig. 12 was taken 
from a man very low with a fatal disease, and Fig. 13 from a 
child ten years old. Figs, 14, 15. Similar cases. 



Fig. 12.— Unhealthy blood. 





Fig. 15.— 1-7 obj. Unhealthy blood. 
69 



TUBEBCULOSIS. 



A demonstration that tuberculosis originates in the blood. 



73 



TUBERCULOSIS. 

SYNOPSIS: 

HISTORY OF A TUBERCULOSIS INFECTION IN THOSE AFFLICTED 
WITH PULMONARY TUBERCULOSIS. — NODULES OR TUBERCLES A 
PRIME NECESSITY FOR TUBERCULOSIS. — ANTECEDENCE OF NOD- 
ULES OR THE GERM OF CONSUMPTION. — PROOF THAT THE NOD- 
ULE IS PRIMARY AND THE BACILLUS ONLY AN ASSOCIATE. 

So far back in history as medical literature can be traced, 
it has been known that tubercles existed in the human sys- 
tem. In 1803, long before the microscope came into general 
use, Bayle* pointed out the tubercle as a pathological 
product. Step by step with use and growth of the microscope, 
knowledge of the morbid anatomy of the cheesy tubercle has 
gradually developed. 

In 1820, without the use of the microscope, it was believed 
that tubercles had their distinguishable forms, "the transpar- 
ent, the semi-transparent, and the opaque." In 1839, Magen- 
die* advanced the idea that "perhaps tuberculosis matter may 
be detected in the blood." He then states that he examined 
a fibrous sac in the heart of a woman who died of phthisis, 
and that he was able by means of the microscope to determine 
that it was filled with tuberculous matter and not with pus. 
Microscopes in those days were crude, and he does not say 
how he differentiated, but he continues: "The Hotel Dieu fur- 
nishes similar ones (cases) which give new strength to my 
persuasion that we shall find in the blood the cause of a host 
of diseases, and in every instance a fresh source of instruc- 
tion." 

"The primitive tubercle is a miscroscopic body,"* so con- 
sidered because of its minute beginning, and it steadily 
grows. ***** "it may be called cellular or fibrous tuber- 
cle * * * * * according as the cellular or fibrous element of 
the tubercle predominates ***** the former being 
the more common." This distinction shows the early recogni- 
tion of the varieties of tuberculosis. The article goes on to 
say that it is difficult to distinguish the fibrous from a small 



*See Bibliography. 



7.") 



76 



DIAGNOSIS BY MEANS OF THE BLOOD. 



fibrous tumor. "W. Addison, in 1849, taught that it (tubercle) 
consists in greater part of corpuscles, like blood leucocytes or 
like the corpuscles of lymph and pus." "Addison believed 
that the lymphoid corpuscles of tubercle were the result of 
exudation from the blood through the walls of the vessels." 
"He pointed out (in 1856) the frequency with which tubercle 
is seated in the outer coat of the small bloodvessels in cerebral 
meningitis." This "scrofula matter (Bayle's granules) prior 
to 1803 was looked upon as wholly a deposition from the blood 
and later (1853 and thereabouts) the tuberculous dyscrasia 
was an accepted term, used to signify that the process origi- 
nated in the blood. This term has been used by many in re- 
cent years. 

It was argued that sometimes the tuberculous process 
started simultaneously in two or more localities far apart, and 
physicians expressed it thus: "It is not asking too much to 
suppose that the common cause exists in the common bond of 
all organs and tissues, i. e., to say the blood." 

Watson,* in 1845, said: "Tubercles themselves are com- 
posed of unorganized matter deposited from the blood of a yel- 
low color and about the consistence of cheese." Addison, in 
1849, taught and others considered tubercle to be composed 
of pus and lymph corpuscles. In 1865, "Woldenburg, Sander- 
son, Chauveau, and most other pathologists, deem it (the 
virus-dyscrasia in the blood) to take the form of minute solid 
particles." 

Viljernin* (1865) began to experiment by inoculating ani- 
mals with tubercle in order to produce the disease. These ex- 
periments seemed to be successful, and thus a new train of 
thought was started. But from the above evidence "Boyle's 
granules of scrofula," Magendie's proof of its being in the 
blood, the fact it started in two places at once, the tubercle 
dyscrasia, Watson declaring that "unorganized matter" in 
tubercle "was deposited from the blood," Addison's tracing 
the deposit from the blood into the small vessels of the brain 
— and his pathology as far as it went agrees with that of to- 



* See Bibliography. 



TUBERCULOSIS. 



77 



day — Woldenburg's and others' belief — show that previous to 
Villemin's experiments it was generally accepted theoreti- 
cally, at least, that tubercle was caused by direct deposit from 
the blood. 

At this time bloodletting was being considered an old-fash- 
ioned practice. This fact, together with the attention of the 
profession to the experiments of Villemin and others, it would 
seem, set back the blood-origin of tubercle in a most positive ivay. 

Friedlander*, in 1872, began to find "lumps of tubercles in 
joints;" before this the matter was thought to be confined to 
the lungs. Although the miliary tubercle has been known 
for years, new meaning seemed no at to be attached to tu- 
bercle. The tubercle became a medical fad and tubercles 
were found more frequently than ever. Then came the an- 
nouncement in 1883 by Koch that he had discovered the cause 
of tuberculosis — the tubercle bacillus. As a result, the theory 
of the blood-origin of the disease was buried deeper than ever. 
But another result of the discovery of the tubercle bacillus 
was that tuberculosis became more widely recognized than 
ever, and to-day it is taught in all our institutions that this 
bacillus is the cause of tuberculosis in all its forms. 

If this bacillus is the cause of tuberculosis, as is generally 
claimed, then the germ must be in the tubercle or, at least, 
about it, even in the tubercle's microscopic form. Conse- 
quently, the germ must be present first. Is it present first? Has 
this ever been demonstrated f It is claimed that these bacilli 
are carried to the tissues by the blood, and still it is acknowl- 
edged that they have never been found in the blood. It is 
generally claimed by pathologists that this germ is the cause 
of all tuberculous lesions. In the books of several authori- 
ties I have failed to find this disease defined as being caused 
by the tubercle bacillus. Yet these authors implied that such 
was the case. It seems they have a less positive word than 
cause. Osier* (1896) says "tuberculosis is an infectious disease 
due to the introduction into the system of the bacillus tubercu- 



* See Bibliography. 



78 



DIAGNOSIS BY MEANS OF THE BLOOD. 



losis, and characterized by the presence of nodular bodies 
called tubercles." Gould defines it "an infectious disease due 
to the introduction into the system of the tubercle bacillus." 
Neither of them quite care to say caused by the tubercle bacil- 
lus. Judging from the wording it would strike one that these 
men were themselves hardly ready to claim that tuberculosis 
was caused by this germ, though admitting that somehow 
the germ must be present. In books where this disease is de- 
fined as being caused by the tubercle bacillus, before the 
authors are through with the subject they beg the question 
by saying that this bacillus is not found in all tubercles. 
Therefore, the most consistent definition according to the ac- 
cepted facts are such as Gould's. 

But to come to the point, what are these tubercles, these 
miliary bodies which we have traced back 100 years as the 
known cause of this disease? The history of these tubercles 
was even known in the time of Hippocrates, and they are to- 
day found in all cases of tuberculosis. What is the composi- 
tion of these nodules,* these tubercles, which Osier declares 
in his definition are as necessary as the tubercle bacillus? 

Authors differ only slightly in their analyses. Delafield* 
says that they are composed of "granular matter, pus-cells 
and epithelium." If the origin of these constituents can be 
explained, then we have explained the origin of tuberculosis; 
we have, at least, come nearer the truth than those who ac- 
cept the theory of the tubercle bacillus. The pus-cells, then, 
are the exudated leucocytes — the epithelium is from the hy- 
perplastic cell-wall in which the deposit is made. This is due 
to physiological functioning which we all understand and 
common sense demands its acknowledgment. It is perfectly 
evident that the only constituent left of a tubercle to be ex- 
plained is the granular matter. To review: There are three 
constituents of a tubercle, (1st) granular matter, (2d) pus- 
cells, (3d) epithelium. The pus-cells are transuded white 
blood cells from the blood vessels. The epithelium is the ex- 
tra deposit from the wall of the air cell with which it is lined 



* See Bibliography. 



TUBERCULOSIS. 



79 



due to the extra work. The granular matter is still to be 
explained. 

We have now to show what this granular matter is, or from 
whence it comes to complete the demonstration. 

In 1895, when I was in Paris, the fact that surgeons had 
successfully operated on tuberculous peritonitis, by simply 
exposing the inflamed peritoneum to the air, and closing up 
the wound, was exciting some interest. Malassez, it was re- 
ported, had had several successful cases. Dr. Murphy, of 
Chicago, whom I met at the time, told me he also had operated 
with the same results. The simple and unaccountable re- 
sult astonished these operators. The astonishing recovery 
of patients from this simple operation is now well known. 
What was the cause of the recoveries no one knew, but it was 
a fact that the tubercle disappeared and the patient recov- 
ered. Was this result due to the exposure of the tubercle 
bacillus to the air, or was it some other consequence of the 
operation?* 

It occurred to me there was a product in the peritoneum in 
these cases similar to one that I had observed for several years 
in the blood of tuberculous people. When a drop of blood 
freshly drawn from a patient suffering from tuberculosis is 
placed under the microscope, granules are seen in abundance. 
These disappear in a few seconds, probably because of expos- 
ure to the air, although this is not positively known. Must it 
not be either that these products in the tubercles of the peri- 
toneum and these granules in the blood are the same or that 
one is the factor of the other? Perhaps the climatic treatment 
of tuberculosis may be explained on this basis more logically 
than on that of the germicide theory. 

The tubercle bacillus, it is claimed by authorities, is found 
in all individuals who have tuberculosis. This being granted 
for the sake of argument, it must be evident that this germ 
must have something on which to live, something to attract it. 
In the laboratories it is cultivated on artificial media. In the 
body it must have a more natural soil. There must be some- 



* See Bibliography. 



80 



DIAGNOSIS BY MEANS OF THE BLOOD. 



thing in the bodies of tuberculous people that is constant. 
What is it? That question was asked more than 50 years ago. 
To-day it can be answered. 

In 1893, in the Loomis Laboratory, I took two tubes of 
blood and planted on each a pure culture of the tubercle bacil- 
lus. These tubes were sterilized and taken under antiseptic 
precautions. In one tube was drawn the blood from the vein 
of a man with advanced tuberculosis, in whom the granules 
were present. In the other was drawn the blood from a non- 
tuberculous patient, in whom the granules were not to be 
found. These specimens were taken from patients in St. 
Catherine's Hospital, Brooklyn. On the tube taken from the 
tuberculous man, the germs developed, while on the non- 
tuberculous no growth was obtained even after six weeks' 
time in the incubator. This seems to prove that there is a 
nidus in the blood of the tuberculous that is absent in those 
who have not this disease. For the benefit of those who think 
that bouillon is the only medium on which this germ will 
thrive (for that is the common medium in the laboratories), I 
Avill state that at the same time these other tubes were in the 
incubator, I placed the same germs in a tube containing cider- 
vinegar as a medium in which Avere pledgets of cotton. On 
this the tubercle bacillus thrived most wonderfully in a short 
time. 

Delafield* says again: "For the development of tuberculous 
inflammation in any part of the body there is necessary the 
proper disposition of the individual," and he, with others, 
said "that the bacilli are transported by the blood." Are 
these men not mistaken as to what is transported by the 
blood? For they acknowledge that the bacilli cannot be 
found in the blood.** Is it not this demonstrated medium that 
is transported by the blood? Is it not these granules that con- 
stitute the disposition of the individual? These can be seen 
in the living blood, and it is no far stretch to thus identify 
them. 



* See Bibliography. 
** See illustration on page 131. 



TUBERCULOSIS. 



81 



From these facts it seems to be proved that the tubercle- 
bacillus is a secondary factor; in fact, a direct result of the 
tuberculous process, instead of its primary cause. Before life 
can exist there must be a medium on which it can thrive or de- 
velop. The body must be nourished or it will die. Herbert 
Spencer says: "Amidst all the mysteries with which we are 
surrounded, nothing is more certain than that we are ever in 
the presence of an infinite, and eternal energy, from which all 
things proceed." So in its more minute forms, food is the only 
source from which life forms can derive energy. The germ 
cannot exist without food, but the food can and does exist 
without the germ.* In other words, these germs are the result 
and not the cause of the pathological process. 

In order to live the germ must necessarily make its home 
where food exists. Man would not think of dwelling in a 
place where his nourishment could not be had. That which 
disease feeds on, then, is primary to the existence of disease, 
and the germ itself secondary. I have heard that it is claimed 
by some authorities that the bacillus of Koch does not make 
its appearance until the tubercles break down. For example, 
they are not found in the sputum until after the lungs or the 
involved tissue undergoes ulceration. This, in itself, is proof 
that the presence of the germ is secondary in the tuberculous 
process and not its cause. 

To sum up, we have shown that: 

1. For nearly a hundred years the cause of tuberculosis 
has been thought to lie in the blood. (It is said in mathe- 
matics that theory runs a step ahead of practice.) 

2. The prime factor in the production of tubercles is mat- 
ter deposited from the blood. 

3. This deposit from the blood is a granular matter which 
disappears on exposure to the air. 

4. This granular matter exists in all tuberculous people. 

5. The germ of Koch will grow in blood containing these 
granules. 

* A horse lives on grass. Grass can live without the horse, and the grass attracts the 
horse when hungry. Still the horse is not always present where grass is growing. To come 
nearer to the subject, we have germs on a stagnant cess-pool, but the cess-pool comes first 
and the germs afterward. The germs do not cause the cess-pools to exist. Neither does the 
tubercle bacillus cause tuberculosis to exist. 



82 



DIAGNOSIS BY MEANS OF THE BLOOD. 



6. It must be these granules, deposited from the blood into 
the air cells, that produce in the lungs tubercles, which "are 
primarily microscopic bodies" in size, and gradually enlarge 
from fresh deposits into "transparent, semi-transparent, and, 
finally, opaque granules," or tubercles, which, in time — "three 
weeks to several years" — break down and form a medium for 
the tubercle bacillus. 

A prominent professor once said that when a number of 
physicians had as many remedies for a single disease (malaria) 
it was pretty good evidence that they did not know the true 
one. But when all agreed on a remedy, then that was a speci- 
fic and they knew what to do. (Malaria.) 

So these granules in the blood have kept physicians in con- 
fusion for years. Some physicians have called them small 
corpuscles — yet they do not resemble corpuscles; others say 
broken down red cells of the blood. Bizzozero called them 
blood platelets or plaques. No two observers seem to agree, 
either on their description or composition. But these gran- 
. ules in the blood are the haematoblasts of Hayem, the yeast 
of Salisbury, the granules of Bayle (1803). It is their com- 
pression or coalescing that gives them their varied forms, and 
largely accounts for these different opinions. They have been 
called the granules of Eanvier and the globulins of Donne. 
They are found in the blood of all tuberculous subjects before 
the tubercle has made its appearance, and long before it has 
formed. 

This granular matter is the "tuberculous matter deposited 
from the blood" of Watson. It cannot be anything else, for it 
is the only foreign matter seen in the blood with a microscope 
and the untrained eye. It is these granules which, on analysis, 
are found to compose a tubercle. This granular matter in the 
blood is in reality the blood dyscrasia spoken of by physicians 
for 50 and 100 years. It would have been seen long ago if blood- 
letting had not died out of fashion, for there was only a step 
to reach it. It exists in the blood months, and sometimes 
years, before the tubercle bacillus enters the system. This is 
plainly demonstrated from the fact that tubercles are com- 
posed of the only granular matter that the blood contains. It 
is this that constitutes the (old) dyscrasia of consumption. It 
is in reality the "tuberculous matter" of tuberculosis. 



TUBERCULOUS FIBRIN. 



TUBERCULOUS FIBRIN. 

SYNOPSIS : 

FIBRIN A NECESSITY TO THE ESTABLISHMENT OF TUBERCULOSIS. 

. Besides the tuberculous matter in the blood of tuberculous 
people, there is fibrin in a characteristic state. This fibrin is 
thicker and appears to be more abundant than in normal 
blood. The picture is so pronounced and characteristic of the 
disease that any attempt at description would be superfluous. 

As the tuberculous matter disappears on exposure to the 
air, the fibrin which is not at first visible gradually comes into 
riew. There is a peculiar clumping or agglomeration of the 
red corpuscles in tuberculosis which is best seen in the pic- 
tures with or without the fibrin. 

SYNOPSIS : 

VIRCHOW'S* FIBROUS NODULE OR TUBERCLE THE BEGINNING OF 
OLD-FASHIONED CONSUMPTION. — ITS CHARACTERISTICS. 

In fibroid tuberculosis of the lungs, or in fibroid disease, the 
red corpuscles are again arranged or agglutinated in a charac- 
teristic w T ay peculiar to the fibroid condition (see illustrations). 

Virchow** and others have described a cellular and a fibrous 
tubercle. The former is the tuberculous, he says, "according 
as the cellular or the fibrous element of the tubercle predomi- 
nates. It may be called cellular or fibrous tubercle." The lat- 
ter, he says, cannot sometimes be distinguished from a 
fibroma. The cellular form is composed mostly of tuberculous 
matter, while the fibroid form is found when the fibroid con- 
dition of the blood predominates in the system. Thus, the 
tumor-like tubercle is formed with the tubercular granules 
present to a slight degree, and they serve as a nucleus. 

This is the beginning of what in the old days was called 
"fibroid consumption of the lungs." The tubercle bacillus is 
not found in this disease until the tuberculous matter is pres- 

* Koch's recent paper on tuberculosis led to the following remark : " Nothing remains for 
me but to maintain more positively than ever my view that the decisive thing in tuberculosis 
is the tuberculous nodule " Tuberkelknoetchen," which is the pathological mark of tubercu- 
losis, and not the bacillus as such." — Prof. Virchow at the London Tuberculosis Congress, 
July 25, 1901. 

**See Bibliography. 

85 



86 



DIAGNOSIS BY MEANS OF THE BLOOD. 



ent in the blood in abundance. It does not* "die," as one 
author said, but it was never present; it appears only in the 
combined tubercular and fibrous diseases (mixed varieties), 
which not uncommonly happens. 

Fibrous consumption, or fibrous disease generally, then, is 
recognized in the blood by the peculiar piling up of the red 
cells together with the characteristic adhesiveness. This ad- 
hesiveness is distinguished easily from the rouleaux arrange- 
ment of health. In this latter it is a cohesion of the cells — no 
sticky matter between the cells. 

I remember recently to have been called in consultation to 
an advanced case in which the tubercle bacillus could not be 
found, either in the sputum or excretions even on several ex- 
aminations. The blood, however, revealed the fibroid tubercu- 
lous arrangement at once, and thus confirmed the diagnosis 
which the attending physician had already made. 

The long experience necessary to get the proper confidence 
in oneself to diagnose this form of disease, accounts largely 
for the slowness of the profession in taking up this method of 
diagnosis. 

I do not desire you to take my experiment (p. 80) as proof; 
consider it nil if you will. But the profession to-day, even the 
bacteriologists, have never proved their claim in tubercu- 
losis. This is shown not only here, but in all the best works 
that I have consulted on the subject. 

Allbutt's "System of Medicine" says (p. 15): "The tubercle 
bacillus is found in tuberculous lesions both in man and ani- 
mals. In a particular lesion the bacillus may be absent, hav- 
ing died. (How does he know it died?) But in one or other 
lesion of the body of a tuberculous animal and in nearly all 
recent lesions (why not in all?) tubercle bacilli are readily 
found." This is a contradiction of his own definition, for he is 
one who defines this disease as "caused by the tubercle bacil- 
lus." I do not claim that the natural nidus of all specific 
germs is known or ever will be, nor would I discourage the in- 
vestigation of germs. But I do insist that in this special dis- 



•See Bibliography. 



TUBERCULOUS FIBRIN. 



87 



ease, the germs when present in the tuberculous process 
are attracted thereby to the primary tuberculous process here- 
tofore described as existing in the blood; hence, they are a re- 
sult, an associate of tuberculosis; and this falls in line with 
the natural progress of things. Many in the profession are 
becoming dissatisfied with the former belief as to the cause of 
tuberculosis and are looking for something beyond. If this 
cannot be read in plain type in authentic text-books, then it 
can be read between the lines. 

I believe that the germ theory of tuberculosis as taught to- 
day is really believed by the minority of the profession. 

During my hospital service, a certain consulting physician 
was accustomed to say: "Ride no hobby. Keep out of ruts." 
I would modify this a trifle, and say: "Keep out of ruts and 
ride no hobby to death." Most great men have had hobbies, 
but the greatest knew when to stop. 

Those who acknowledge the tubercle bacillus as the cause 
of tuberculosis claim to have proved in their own way that 
the tubercle bacillus is always found in the tubercle, and that 
it is its producer. They say these bacilli have never yet been 
found in the blood, yet they assert there is something in the 
blood which not only produces but predisposes to the disease. 

On the other hand, I have shown that there is a "seeable" in- 
gredient in the blood in all cases of tuberculosis. This matter 
is acknowledged by pathologists to be a primary ingredient of 
the tubercle, being seen long before the tubercle bacillus can 
be found. 



FURTHER DISCUSSION. 

SYNOPSIS : 

IS THE EXPERIMENT OF INOCULATING ANIMALS A NECESSITY ? — 
IB IT THE METHOD OF STUDYING DISEASE WHEN OTHER MEANS 
ARE AT HAND? — THE RESULT OF THIS WORK IS CONFIRMED BY 
AUTHORITIES. — TUBERCULOUS MATTER CAN BE SEEN BY ANY 
PHYSICIAN — CALL IT WHAT HE WILL. 

It would seem to some that we ought to consider in our dis- 
cussion the claim that "the inoculation of susceptible animals, 
with the tubercle bacilli, produces the disease." Therefore, 
we will give space for a little of this. For this, it is claimed, 
it seems by bacteriologists, is an iron-clad rule establishing a 
germ to be the true cause of a disease. It will be noted that 
the adjective susceptible always modifies the noun animal 
whenever an inoculating experiment is successful. It re- 
minds us of the phrase used so often in surgical parlance: 
"The operation was successful, but the patient died." It is 
self-evident that all animals which are injected with these 
bacilli do not develop or contract the disease. The question 
would naturally arise, what constitutes this susceptibility? 
I do not care to go into this discussion further than to say 
that the susceptible animals I have observed contain this 
tuberculous matter in their blood. 

Sternberg's Bacteriology, p. 393, says: "They (tubercle 
bacilli) are more numerous in tuberculous growths of recent 
origin, and often cannot be demonstrated in caseous material 
from the center of old nodules." Here it would seem is a state- 
ment proving that the germ is not the cause, for the author 
says it is not found in all tubercles. But to go on: "Such ma- 
terial when inoculated into susceptible ahimals gives rise to 
tuberculosis, and the usual inference is that it "contains 
spores of the tubercle bacillus." They thus imply that it con- 
tains the infecting agent. 

It has been, and is still, claimed that the old experiments of 
inoculating animals with other things than the tubercle 
bacilli have produced the same tubercles. One can poison 
any animal by injecting large quantities of these bacilli into 

89 



90 DIAGNOSIS BY MEANS OF THE BLOOD. 

its system, and then, even long afterward, it will be found 
that the germs have actually increased in the system; but 
this is not the natural soil for these germs. For in its 
natural soil, at its proper time, the germ will come, and 
that time nature will decide. When, at that time, the soil 
and the germ will be associated, tuberculosis will be found. 
A number of animals with a certain limited amount of in- 
ferior food can be isolated on an island— the animals will de- 
velop and redevelop (the same as the germ), yet these animals 
— inferior animals at that — live a long time even on the in- 
ferior food. 

Conditions such as the above, it will be seen, are unnatural. 
But suppose it is true, as it is claimed to-day by bacteriolo- 
gists, that all susceptible animals inoculated with the tuber- 
cle bacilli develop tuberculosis. Let this sentence stand 
while we examine the facts. 

Is any man who believes in the contagious nature of this 
disease going to allow another to inject these germs into his 
system? Does such process naturally occur in nature? You 
will answer "Certainly not!" Then why bother about the re- 
sults of such unnatural methods? The true way to study dis- 
ease is to examine it when not artificially produced. 

The four rules laid down by Koch* (1882), in order to prove 
that a germ is the cause of a disease, briefly are : 

1. The finding of the germ in the diseased body. 

2. Its cultivation on an outside medium. 

3. The reintroduction into the body of this recultivated 
germ with the production of the characteristic lesions. 

4. Noting that a greater number of germs are produced in 
the animal than were introduced. 

With the exception of the first, these rules are all artificial. 
They are being dropped to-day, for they are found to be merely 
theoretical. 

For example — the Plasmodium of Laveran, which is the 
recognized germ of malaria, has never been cultivated outside 
of the body, and its reintroduction when found outside is not 



* See Bibliography. 



FURTHER DISCUSSION. 



91 



acknowledged to produce the disease according to Koch's 
rules. 

These three rules are illogical, unnatural and mechanical. 
1 mean by mechanical that in order to get these results instru- 
ments are used, such as belong to the artisan. Such methods 
are not made use of in nature. 

The fact that Cohnheim* some years ago claimed to have 
produced tuberculosis by inoculating non-tuberculous matter 
into animals, and now makes the statement that he cannot 
now get these results, and falls in line with the accepted bac- 
teriological theory — this fact, I say, is sufficient to prove that 
the method is unscientific and untrue. Therefore, these re- 
sults must fall into disuse. 

The fact that the profession recognized the malarial para- 
site without its being artificially cultivated clearly shows 
that they at present recognize the true method of investi- 
gating disease. The constant presence of the Plasmodium in 
malaria establishes, as near as any one can, its etiology. I do 
not belong to the anti-vivisection society; and I have experi- 
mented on many animals, but in the investigations connected 
with this subject it has not been necessary to kill or inocu- 
late any animal to find the truth. This work can be and has 
been done by long patient observation and investigation ex- 
tending over years. It is done on the living human being, 
without causing injury, pain or inconvenience of any kind, or 
even leaving a scar. 

But more than that, the work represented in this book is 
confirmed by unsought autopsies, as well as demonstrated by 
the recorded result of post-mortem examinations reported in 
both ancient and recent authentic text-books of Pathology 
and the Practice of Medicine. 

In regard to the contagiousness of tuberculosis, we will say 
with Watson* that its "very dependence upon a peculiar 
diathesis would seem to disprove the supposition." He says:* 
"Is phthisis contagious? No. A diathesis is not communi- 
cable from person to person. Neither can the disease be easily 



*See Bibliography. 



92 



DIAGNOSIS BY MEANS OF THE BLOOD. 



(if at all) generated in a sound constitution. Nor is it ever im- 
parted in my opinion even by one scrofulous individual to an- 
other. Yet in Italy (1845) a consumptive patient could not be 
more dreaded and shunned if he had the plague. A girl dying 
of phthisis is nursed by her sister, who afterwards droops 
and dies of the same complaint. But the parties may be differ- 
ent in blood. (He means not related.) A wife watches the 
deathbed of her consumptive husband, and presently sinks 
herself under consumption; and there may be no traceable 
or acknowledged example of scrofula in her pedigree. Tet 
even here the latent diathesis may fairly be presumed to have 
existed. Very few families are perfectly pure from the stru- 
mous intermixture. The predisposition may be slight; it may 
be dormant for a generation; or like other inherited peculiari- 
ties it may light capriciously on some individuals only of the 
kindred. In both the supposed cases there have been other in- 
fluences at work more authentic than the alleged contagious 
property (nowadays considered the tubercle bacillus) in call- 
ing forth the fatal malady. Watching, the want of rest, con- 
finement in the unwholesome air of a sick chamber and, above 
all, protracted mental anxiety, than which no single cause, 
perhaps, has more power to foster and forward the inbred 
tendency to phthisis. The disorder, I am satisfied, does not 
spread by contagion. 

"Nevertheless, if consulted on the subject, I should for ob- 
vious reasons dissuade the occupying of the same bed, or even 
of the same sleeping apartment, by two persons, one of whom 
was known to labor under pulmonary consumption." 

It will be seen that in this short quotation of opinions ac- 
cepted fifty-five years ago, are embodied many of the ideas 
that are favored to-day; i. e., that the disease is contagious or 
infectious because there is a germ connected with the disease 
and which has been considered its cause. It will, however, 
be found that the predisposition must exist before the germ, 
and the germ only is the cause of a contagion (so authorities 
contend). 

It is said that when two clocks with different beats are 



FURTHER DISCUSSION. 



93 



placed side by side, after a time the tick of one approaches 
the tick of the other. 

It is well known that when an exceedingly nervous person 
is constantly brought into the presence of a moderately ner- 
vous person the latter will after a little become as badly 
afflicted as the former. 

With this tuberculous matter in the blood, then — to the 
same degree and in the same style is tuberculosis contagious. 
But if tuberculosis is contagious without this predisposition, 
then health is much more so. It will thus be seen that, consid- 
ered at its worst, it is a matter of virulence or degree. 

It is claimed by many that tuberculosis originates in the ali- 
mentary canal. If not wholly true, this is partially so; for dis 
order of the secretions of the stomach or intestines* is often 
associated with this complaint. 

The great Paganini,* the violinist, who held the musical 
world for years with his warbling string, suffered from tuber- 
culosis of the bowels, and died of it in 1840. It is said that 
when exacerbations of illness came on he suffered intense 
pain. And he had them every time he overindulged at the 
table. He was so easily tempted that in later years he seldom 
attended banquets. In most patients the disease does not 
show such marked and painful symptoms as it did in this 
great musician, who finally died of tuberculosis of the lungs. 
But in almost all cases this tuberculous matter can be traced 
in the lymphatic glands, the stomach, or the lacteals, which 
help metabolize the food before it is taken into the system. 

Here, again, is a partial explanation as to why patients 
afflicted with tuberculous peritonitis recover when the sur- 
geon exposed the thinly-lined tubercles in the peritoneum to 
the oxygen of the air and light of day. These agents suddenly 
change their chemical composition, and they are absorbed or 
discharged in or from the body by this new chemical process. 
It often takes years for them to re-form or re-deposit. I claim 
that these deposits are due to disorder of the secretions of the 
stomach or bowels, or both, and that accidental cures — as the 



*6ee Bibliography. 



Hi 



DIAGNOSIS BY MEANS OF THE BLOOD. 



surgical operation referred to above — and climatic changes are 
also due to accidental changes in diet, as well as to change in 
hygienic conditions. I have often observed that when infants 
are given quantities of sweets this tuberculous matter in the 
blood is increased, while the discontinuance of such ingesta 
is followed by a reduction of tuberculous matter in the blood. 
It is claimed by some that tuberculosis of the lungs is due to 
vegetable feeding. This seems to me to be overdrawn, but 
that it is due, partially at least, to fermentation* must be true. 
1 have never seen this statement discussed; I do not believe 
it can be intelligently disputed. 

That the chemical changes produced by foods in this affec- 
tion lead up to and produce disease in the stomach and bowels, 
and thus clog up the organs which should absorb, is, or should 
be, a well-known fact. The nerves that control these absorb- 
ing organs being paralyzed or partially so, the intestinal 
products flow into the blood-stream. 

The reason some people who have tuberculous matter in 
their blood never develop tuberculosis is because of their great 
nerve power. The nerve power or fluid, or force, or whatever 
it is called — that current that flows over the nerves — is able, 
when reinforced, to cure more disease than food is. It is not 
considered often enough in treating disease. Stopping up the 
leaks of the nerve fluid, in order that one can store the more 
of this energy, makes them the stronger to overcome tubercu- 
losis or any other disease. 

The only other condition to add is that the conductors 
should then be in proper trim, and the patient skilled with the 
proper knowledge to distribute this force. This is where the 
physician's business comes in — to properly trim the wires. If 
he can do it the patient will recover. If the patient had the 
proper knowledge he could cure himself. Just as a great 
dynamo is set going when the wires are properly stretched and 
protected with the proper instruments in order at their ter- 
mini, then everything runs smoothly and harmoniously. But 
if an instrument breaks or a wire loses its insulation and a 
short circuit is produced by large enough contacts, then the 

* See Bibliography. 



FURTHER DISCUSSION. 



95 



machine spits fire and stops — dies. Similarly does man's en- 
ergy give out, his nerves cross, cause pain or possibly flashes 
before his eyes, he often sees stars, and, if force enough is 
used, he also dies. When we are born, just so much life is put 
into us, and no more ever comes. 

If any of my readers are still inclined to hold that the mi- 
crobe is the only means of diagnosing this disease (tubercu- 
losis), I will remind them that here is a substance, a particular 
kind of matter, that you can see in the blood as soon as you 
put your eye to the instrument; it can be seen long before the 
tubercle bacillus can be found in the sputum or in any of the 
fluids or solids from the body. 

I ask that you take this as a means of warding off disease. 
Take these granules in the blood as an aid to diagnosis where 
none other is at hand and consider it; if you will — ■ — well, con- 
sider it what you please, but use it. 

The photo-micrographs, I hope, will make this matter plain. 



PULMONARY 
TUBERCULOUS CASES. 



PULMONARY TUBERCULOSIS. 



ILLUSTRATIVE CASES. 

CASE I. 

The blood here represented is that of a physician sent me in 
April, 1899, for diagnosis. 

I wish to say that when patients are sent me by physicians 
I seldom make a physical examination of the chest unless re- 
quested. My chief interest is in the appearance of the blood 
and not in general physical examinations. 

The blood showed at once that the case was one of tubercu- 
losis of the lungs. 

Dr. Curtis afterward told me that his patient had been ill 
one year, had quite a severe cough and that there were rales 
heard over the chest. He was on his way to the mountains. 

I show here several photographs of the same specimen 
taken at different intervals— about five minutes apart. 

In the first it will be noted that the tuberculous matter is 
not only distinct but abundant. Fig. 16. 

In the second, Pig. 17, the tuberculous matter has disap- 
peared somewhat, as it naturally does on exposure to the air; 
and it will be noted that the contracting fibrin is making its 
appearance. Note its fineness. The red cells are clustered to- 
gether in small bunches. The specimen, as a whole, is very 
characteristic of the disease. 

The last two photographs, Figs. 1S-19, show the fibrin and 
cells; the tuberculous matter has nearly disappeared. The 
white blood cells are increased in number here and are 
ameboid. 

This is an advanced case. I have not seen the patient since, 
but I am sorry to say that he will not recover. He was 60 
years old, and had done a large country practice. 

********** 

I have since learned that he lived one year. 
Fig. 20 is characteristic tubercular blood. 



100 



DIAGNOSIS BY MEANS OF THE BLOOD. 



CASE II. 

A friend brought in a gentleman 46 years old, as a patient 
for diagnosis and treatment. He had been away to the coun- 
try for a few weeks, but it seemed to do him no good for he 
was continually losing flesh and getting worse rapidly. 

This man was being treated with quinine for malaria. His 
temperature, he said, had been up to 102°. The skin was soft 
and damp. Because of his appearance and the lack of diag- 
nostic symptoms, I began by examining the urine. The only 
symptom he gave was pain in the bowels together with the 
fever. The urine showed specific gravity 1,030, no albumen, 
no sugar, but a great proportion of biliary matter. A month 
previously he had suffered much from pain in the ri,ght iliac 
region, I should say where the ileam joins the cecum, or near 
the appendix. He had soreness there still. It is a wonder he 
had not been to a surgeon for operation. 

Nothing of special import having been found in the urine, a 
drop of blood was taken and placed under the microscope. It 
is illustrated here, Figs. 21, 22, 23, 21 and 25. I give several 
photographs — two of the same drop two minutes apart, and 
three are of different drops from the same man — in order to 
show the general arrangement of this kind of blood. 

The appearances clearly indicate that this man had tubercu- 
losis of the lungs. Other photographs taken from the blood of 
this patient are shown on a following page. 

On inquiring as to the existence of a cough, he said: "Oh, 
yes, I have had a cough for the last six months." 

"Do you raise anything?" 

"Oh, yes; in the morning." 

A specimen of the sputum was afterwards sent to the Board 
of Health, and they found the tubercle bacillus. It was learned 
afterwards that he had fever and night sweats. 

A physical examination of the lungs revealed the character- 
istic symptoms there. 

The sunburn on the man's face, the pain in the side, and the 
statement made that he had malaria would naturally throw 
one off his guard. He died in six months. 



PULMONARY TUBERCULOSIS. 



101 



CASE III. 

While coming up from the Thirty-fourth street ferry re- 
cently, some one hailed me in a happy tone of voice. I turned 
back in the crowd to see a stout young fellow fairly radiant 
with good health. I could not for the moment place him. 
Seizing my hand, he began : 

"You doctors in Bellevue Hospital told me a few years ago 
that I had consumption. Do you remember? I was in bed 
there several weeks, and even left there nothing but a skele- 
ton." 

After thinking a minute, I recollected, and said: "Oh, yes; I 

now recall you, Mr. . It was the spring of '94. You did 

have consumption. I have a photograph of your blood to- 
day." 

The record of that strong man's illness showed that he had 
had rales at the apex of both lungs and all over the left, to- 
gether with much consolidation. He had profuse night sweats, 
and spat up much blood and mucus. The tubercle bacillus 
was found in his sputum. I think the case w T as complicated 
with pleurisy in its early stages. 

Fig. 29 is a photograph of the blood as it was in Bellevue. 
The adhesiveness of the corpuscles wall be noted; there is a 
slight increase in the white cells, and a faint outline of fibrin. 
The tuberculous matter is present in the serum in two places, 
but is somewhat faint, probably because the blood had stood 
so long before the picture was taken. 

I may say that in this case the treatment was of little avail. 
Rest was the great requisite, and the fact that the boy was 
blessed with a robust constitution was a great factor. He 
went to the country, he says, and drank a good deal of milk. 
We all thought when he left the hospital that it was simply a 
case of time, and short time at that, for w T hile there he appar- 
ently got worse instead of better. He came over to my office 
the day after I had met him, and Fig. 30 is the photo-micro- 
graph obtained. You will readily see the change — no tuber- 
culous matter, very little adhesiveness of the cells, and the 
white cells normal. 



102 



DIAGNOSIS BY MEANS OF THE BLOOD. 



I would like to say that by the permission of Dr. Charles L. 
Dana I was that summer examining the blood of patients 
under the service of my brother in Bellevue Hospital. 

CASE IV. 

These pictures of blood illustrate two entirely different con- 
ditions which, from the physical examination, appear to be 
similar. They are reproduced here in order to show this 
special and not uncommon condition which I believe can only 
be made out by a blood examination. 

Fig. 31 is from the blood of a woman sent to me by Dr. 
Ward B. Hoag. Two years ago the patient had a cough which 
lasted about a year. For the last few months she has been 
very well. There has been no cough and no night sweats at 
any time. At no time has she been unable to be about. Six 
weeks ago she was feeling as well as usual upon retiring, but 
in the night, on awakening, she noticed a peculiar feeling in 
her throat, and soon spat up some blood. The temperature 
was never over 100°. This condition continued a little at a 
time for two or three days. There was no expectoration of 
mucus at this time, yet two years ago there was very much. 
Tuberculosis was at once suspected. A physical examination 
revealed a dull spot over the left lung near the angle of the 
scapula. Mucous rales could be heard for two or three weeks 
in this region in a space about four inches in diameter, and 
there was also a spot on the right side. There was, no doubt, 
a hemorrhage from the lung. The microscopical examination 
of a drop of blood from the wrist revealed the con- 
dition as seen in Fig. 29; there was no tuberculous mat- 
ter; the cells were fairly well arranged. In other fields not 
shown here crystals of various kinds and some fat globules 
were seen. From these facts, therefore, the case could not 
have been tuberculosis. The diagnosis in this case was a 
fibrous or sclerotic condition of the entire arterial system, par- 
ticularly in the lungs. Of course, this woman might develop 
tuberculosis of the lungs, but if she takes good care there will 



PULMONARY TUBERCULOSIS. 



103 



be no permanent injury. Only by persistently disobeying the 
laws of health can she acquire tuberculosis. 

Fig. 32 is the blood taken from an Armenian woman sent 
me for diagnosis by Dr. G. Lenox Curtis. She could speak no 
English. The comparison of these two cases is very apt. The 
collecting of the cells in this case in small bunches, together 
with the tuberculous matter present, but not shown in this 
picture, tells at once that this woman has tuberculosis of the 
lungs. There can be no question about it, especially after the 
history of the cough is given. This woman has not long to 
live. But the former (note the difference in the arrangement 
of the red corpuscles) may live for years. When the former 
was told that her condition was not dangerous, the relief to 
herself and family can better be imagined than described. 
Confidence and hope sometimes are half the cure. 

CASE V. 

Mrs. O. has had a chronic cough for many years. When 
these two photographs were taken she was 75 years old, but 
did her own housework, in spite of the fact that she had slight 
hemorrhages occasionally, and great difficulty in breathing. 
The expectoration, of course, was full of pus-cells, but no 
crystals like those found in asthma. It was one of those cases 
of so-called "old-fashioned consumption of the lungs." 

The circumscribed piling up of the red cells is very charac- 
teristic of this hemorrhagic fibrous consumption, and is well 
shown in this photograph, Fig. 33, which was taken in 1894. 
It is useless to try to describe this picture, for it can really 
best be understood by observation. It will be noticed that 
there is no tuberculous matter here, for this case is not that 
form of the disease. Still, it is present more or less when the 
tuberculosis exists as a complication. The woman had this 
affection twenty years or more, and died of this disease in 
1899, after having been confined to her bed several weeks. 



104 



DIAGNOSIS BY MEANS OF THE BLOOD. 



CASE VI. 
INHERITED TUBERCULOSIS. 

Through the courtesy of Dr. E. A. Tucker some years ago, I 
was allowed the privilege of examining some infants of tuber- 
culous mothers in the Sloane Maternity Hospital. The doctor 
was kind enough to telegraph me when a child was born, and 
then I had the privilege of making the examination of the 
child's blood before it nursed. Out of about 11 cases of births 
from tuberculous mothers, I remember to have found only 
one infant in which the tuberculous matter was not found. 

The following are very poor photographs — a mother's blood, 
Fig. 34, and her babe, Fig. 35, showing the tuberculous matter 
in both. 

Note the short rouleaux, which are characteristic of infants' 
blood. The infant's blood is the nearest approach to health, 
and is, therefore, used as the standard. 

CASE VII. 
Fig. 36. 

In 1894 a gentleman wanted to send me a test case. He, 
therefore, sent a young lady about 17 years old who had a 
severe cough, and was emaciated and anemic. She had been 
for a long time under the care of a physician, who was treating 
her for tuberculosis of the lungs. 

Referring to the photograph, it will show that the blood is 
perfectly free from tuberculous matter, and is otherwise in 
very good condition. She was told that her lungs were all 
right; that there was no tuberculosis. She went home, 
stopped taking medicine, and is to-day a stout and healthy 
young woman. The relief from the idea that she had tuber- 
culosis acted like a tonic, and it was the change of her belief 
that acted as the remedy. Fig. 36. 



RECOVERY FROM TUBERCULOSIS. 



105 



CASE VIII. 

RECOVERY FROM TUBERCULOSIS. 

This gentleman, whom I had known for many years, is of 
medium height; his occupation for man}- years was that of a 
teaclier and student of literature, and he was subject to great 
mental strain. Naturally, he did not have a robust-appearing 
constitution. His occupation at the present time allows him 
more leisure; thus, he has more opportunity to take care of 
his health, aud his physical appearance indicates that such is 
the case. 

The arrangement of the blood here illustrated shows it to 
be that of about as perfect health as can be, so far as the ar- 
rangement of the cells is concerned. The proportion of white 
to red corpuscles is normal and the color is good; there is 95 % 
hemoglobin. There was no tuberculous matter whatever and 
the movement of the cells en masse was very good. The rou- 
leaux are marked and the adhesiveness of the cells is slight. 
They are quite elastic. Therefore, it can be said of this man, 
from the blood here shown, that his vitality is good. He has 
little or no articular rheumatism. There is no tuberculosis 
and no predisposition to it. It would, therefore, at his age 
(about 44), be difficult, if not impossible, for him to acquire 
tuberculosis in any form; and his prospects, so far as the blood 
shows, are for a good, long life. 

Eighteen years ago this man suffered from hemorrhages, 
cough and expectoration, together with shortness of breath, 
emaciation and great weakness. He was so ill that his physi- 
cian, Dr. A. L. LoOinis, advised him to go to the south of 
France with the prognosis of recovery doubtful. His condi- 
tion was such when he arrived in Mentone that his end was 
expected at any time. Dr. Loomis' diagnosis was tuberculosis 
of the lungs. This illustrates another case of recovery of this 
dreaded disease. Fig. 37. 



106 



DIAGNOSIS BY MEANS OF THE BLOOD 



CASE IX. 

ULCER OF STOMACH. 

It is impossible in a book of this size to give all the diseases 
or all the modifications of disease that are capable of being 
discovered or differentiated by the blood examination. Often 
a trivial query, and either a positive or negative reply, will 
aid more in getting at the true disease than is at first thought 
possible. The photograph following is one of the negative re- 
sults that in connection with the examination of fresh blood 
sometimes settles a point of serious importance to the pa- 
tient. 

This man, about 40 years old, had for at least a year been 
suffering with hemoptysis. He said he did not cough, but the 
blood simply came up. He was emaciated and very much run 
down. He naturally thought that he had tuberculosis of the 
lungs. He had no night sweats, but it is not necessary for a 
person to have that symptom in order to have tuberculosis. 
The blood, it will be noted, was free from tuberculous matter, 
and the arrangement of the cells is more that of rheumatism 
than consumption. The fibrin is more of the normal variety, 
and it will also be noted that there are a number of microcytes 
— dwarf red cells — in the photograph. 

But what I want particularly to call attention to is the ab- 
sence of tuberculous matter. Fig. 38. 

The diagnosis in this case was ulcer of the stomach. After 
a year's treatment the man made a good recovery. 

********** 

A microscopic examination of the expectoration was after- 
ward made, but nothing but blood and pus-cells was there. 

The blood in this case was of value as a negative diagnosis; 
i. e., it eliminated what it might have been, and the rest was 
settled by the diagnostic ability of the physician. 

It is here, again, well illustrated that the hematologist 
should not only be a general practitioner, but that he should 
continue to keep posted on all diseases. 




Fig. 17. — Same as Fig. 16, two minutes later. Tubercular matter disappeared. 

107 




Fig. 19. — Fibrin still more plainly seen ten minutes after above. 
109 



Fig. 20. — 1-9 obj. Tubercular matter and fibrin plainly seen in the fluid portion ot 

the blood. 





Fig. 22.— 1-9 obj. Two minutes after Fig. 21. 
113 




Fig. 26. — 1-9 obj., Case II. Two weeks after first examination. 
117 



Fig. 27.— 1-9 obj. Two minutes after Fig. 26. Tubercular matter still faintly seen in 

the field. 





Fig. 30.— Case III. After recovery. 
121 



Fig. 81.— Case II. Patient thought she had tuberculosis, but photo shows she did not. 




Fig. 33. — Case V. Illustrates the fibroid arrangement of cells. 




Fig. 34.— Tubercular mother's blood. 
Figs. 34-35 show that Tuberculosis is transmissible from mother to child. 



Fig. 35.— Case VI. Child's blood slightly tubercular— upper left corner. 




\ 



/ 



/ 



Fig. 38 — 1-6 obj., Case IX. 




SEPTICEMIA 

(BLOOD POISONING.) 



The blood poisoning illustrations here shown are all taken 
from puerperal cases. Under the head of miscellaneous will 
be found one or two photographs taken of other forms of blood 
poisoning. There is a general look, however, about all of 
them, indescribable, but characteristic. 



135 



SEPTICEMIA. 



In the limited number of cases of this disease that I have 
seen I have observed that the blood shows a great amount of 
serum at the expense of the red corpuscles. 
. There are many cocci (germs) scattered throughout the field. 
The appearance is well illustrated in the two pictures here re- 
produced, and is characteristic. Figs. 39 and 40. 

The red cells are scattered throughout the field of the micro- 
scopic specimens and seem to float and turn over on them- 
selves in a lazy, careless kind of way without showing any 
flabbiness or poikilocytic tendency, while the individual cells 
simply float idly about, becoming finally stationary, and give 
a peculiar anemic appearance, which can be recognized only 
by one having long experience in examinations of fresh blood. 
One gets the same idea from the behavior of the cocci in this 
disease as they do from the red cells. 

The first photograph is the blood from a young woman after 
a miscarriage. She was in the maternity ward of Bellevue 
Hospital, on February 28, 1895. This was the third day after 
entrance, when the temperature was 105°. She made a good 
recovery. The pre-tuberculous condition was present and 
more marked than is shown in this picture. 

The second photograph here is from Mamie W., 22 years old, 
who was confined in Sloane Maternity Hospital. On the 12th 
day she developed a fever and the thermometer indicated 
101.7%. There was no special cough, but the irregular tem- 
perature before this made Dr. Tucker suspicious of a tubercu- 
lous complication. 

After a few days, when the temperature was down to 102°, 
the blood was examined and the photograph here shows its 
septicemic, as well as its pre-tubercular condition. 

I remember a physician's wife whom I examined about this 
time — February 27th, I think. It was thought that she un- 
doubtedly had blood poisoning, and that the streptocci 
would be found in her system in abundance. About the tenth 
day after confinement she had been taken with a fever which 
was very persistent and uncontrollable. She had a slight 
cough and, finding such an abundance of tuberculous matter 

137 



138 



DIAGNOSIS BY MEANS OF THE BLOOD. 



present in the blood, I was fearful at the time of tuberculosis 
of the lungs or general tuberculosis. She, however, made a 
good recovery, and remains well to-day. If, then, I had been 
as well informed on fibrin as to-day, I would have known that 
her blood disposition pointed more toward the rheumatic or 
fibrous formations than toward lung tuberculosis. The fever 
will often hide this fact, and one must be careful to take every- 
thing into consideration. 

It is well to remark here that I have never examined the 
blood in a case of septicemia yet, that it did not contain 
tuberculous matter. The question would naturally arise : May 
it not be that pre-tuberculous women are more prone to blood 
poisoning after a confinement or an abortion than others? 

If that should be found to be the case, it would be in order, 
perhaps, to say that non-tuberculous parturient patients are 
immune to septicemia. 

I remember, years ago, when in general practice, to have de- 
livered a poor woman, at least 45 years old, of her first child. 
My hand, when placed over the uterus during the course of the 
labor, and even when this organ was contracting after de- 
livery, felt many small nodules or knots. The woman had the 
best attention she could afford, but, in spite of everything, she 
developed septicemia and died inside of a week. I have since 
thought that she was tuberculous, and these were the nodules 
1 felt. She was also addicted to the use of stimulants. 

The same year, 1895, I was called to examine the blood of a 
fine, handsome and really healthy-looking woman for Dr. E. 
Bradley, a well-known practitioner of this city. She was hav- 
ing an unaccountable and irregular fever, the cause of which 
several consultants could not determine. The tuberculous 
blood was plainly visible on examination. 

An operation — an exploratory incision — was performed by 
Dr. H. D. Hanks to see if there was uterine or ovarian trouble, 
and a pus tube was found. The wound was closed, but blood 
poisoning set in and the woman died. 

I simply mention these cases which came under my observa- 
tion, without intending to convey the impression that such re- 
sults always follow. 




Fig. 40.— Blood Poisoning. 
Also see Fig. p. 339. 

139 



BLOOD IN RHEUMATISM. 



Rheumatism shows in the blood whenever it is in the sys- 
tem, whether or not the person has an attack at the time of ex- 
amination. 



143 



FIBRIN-RHEUMATISM. 



Fig. 41. The first photograph here shows normal fibrin as 
seen in the serum of the blood. It is composed of fine short 
filaments rather closely packed and resembling a spider's web. 
It pervades the entire arterio-venous system with its invisible 
network, existing in the brain, the lungs, the heart, the stom- 
ach; spreading through every organ and capillary of the body, 
ever circulating and performing its function, which is as dis- 
tinctive and as essential as that of the red or the white cor- 
puscle. Thickened fibrin is one of the pathological conditions 
of the blood. 

It is this thickened fibrin which collects the various crystals 
and insoluble particles that pathologically exist in this cease- 
less river of the system as it splashes its contents against some 
sensitive neuron or its dendrite, and finally deposits them on 
the valves of the heart, or swashes its ingredients into some 
non-anastamosing vessel or capillary, or into some already 
painful joint. If the former deposit occurs in sufficient quan- 
tity, we have valvular disease of the heart; if the latter, it is 
rheumatism of the joints. 

The red blood cells float in the centre of the blood serum in 
the capillaries, and the white cells, together with the fibrin, 
float next to the wall of the blood vessel. Because the fibrin 
is next to the capillary wall, and because physicians have not 
squeezed the blood out of the wound and thus obtained the 
fibrin, are reasons why they have only occasionally seen this 
network in the blood when they have examined it. It is the 
contracting of this fibrin which causes the pain when a rheu- 
matic is exposed to a draught, and it is its contraction on ex- 
posure to the air that makes it visible. It is the elastic con- 
tracting and expanding of this fibrin which causes the cor- 
puscles under the microscope in freshly drawn blood to slowly 
sway backward and forward. 

In rheumatism the fibrin filaments are longer and much 
thicker than normal. Fig. 44. Therefore, the fibrin network 

145 



146 



DIAGNOSIS BY MEANS OF THE BLOOD. 



spaces are closer together. In rheumatism the red cells ad- 
here and pile themselves on each other as seen in the photo- 
graphs. See Figs. 42 and 43. 

There are crystals of various kinds in rheumatic blood. 
Rheumatism, then, may be defined as a thickened condition of 
the blood elements, together with the presence of various salts 
and crystals. From this it may be perceived that there are va- 
rious forms of rheumatism. 

There is uric acid rheumatism, in which uric acid crystals 
are seen in the blood. These have been very ingeniously 
separated by Garrod,* of London, by placing threads of silk 
in the blood, and allowing the crystals to collect. This proced- 
ure is not necessary, however, in all cases, for if the blood is 
saturated with uric acid any excess is insoluble in the blood, 
and will crystalize out. It is then perfectly visible under the 
microscope. See Figs. 56 and 57. 

There is phosphatic rheumatism (Fig. 53). There is rheuma- 
tism due to an "excess of oxlate of lime. Cystin crystals are 
seen in Figs. 58 and 59, and cystinic rheumatism in Fig. 60. 
Fig. 61 is uric acid. 

The most common varieties are probably uric acid and cys- 
tinic rheumatism. These deposits occur slowly for years, al- 
most imperceptibly, clogging up the joints, until the patient 
has what is so well known as articular rheumatism, and, 
finally, arthritis deformans. 

These crystals may deposit in any joint and produce pain 
wherever they occur. The cystin often deposits in the en- 
cephalon, producing rheumatic headaches. Crystals of cystin 
have been so little written about and much less known, be- 
cause no one has called the attention of the profession to them, 
that I shall quote* for the benefit of those who may never have 
had their attention called to these recently recognized crystals 
which are so very common in rheumatics, and are the cause of 
1he cystinic variety of this disease: 

"Cystin is insoluble in water and alcohol. It is dissolved 
by the mineral acids and oxalic acid, the fixed alkalis and 

* See Bibliography. 



FIBRIN-RHEUMATISM. 



147 



their carbonates. It is soluble in ammonia, from which it is 
deposited, unchanged, on the evaporation of this volatile 
alkali, but is insoluble in carbonate of ammonia; hence, it is 
best precipitated from its acid solution by that reagent and 
from its alkaline solution by acetic acid. It is hexagonal in its 
crystalline typical form. 

"Its presence in the microscopic examination of blood is 
solely determined by its well known and characteristic ap- 
pearance in the urine. No other crystals found in the blood 
or urine are at all likely to be mistaken for cystin, whatever 
their form or departure from their strict type may be. 

"When the rays of light from the mirror of the microscope 
pass at right angles through the face of the crystal, it appears 
bright and clear like glass. The rays of light that strike the 
crystal at an oblique angle cause such surfaces to look black, 
so that the crystal is made to have very clean-cut sharp lines. 

"The hexagonal form has been found in the substance of the 
liver, but in the blood the crystals are mostly irregular or 
seldom hexagonal, due probably to their floating about and 
rubbing the walls of the blood vessels. The crystals are very 
friable, and often are seen in the blood as crystalline particles, 
grouped, but whatever their form or whatever their size, seen 
either singly or en masse, the crystals never lose their charac- 
teristic appearance. Sometimes a crystal is found in the blood 
so obscured by the coloring matter of the blood, or so en- 
veloped in blood cells or broken-down epithelium from the 
walls of the blood vessels, that nobody can tell what particu- 
lar kind of crystal it is. Cystin calculus is very rare, in spite 
of its total insolubility in pure water, and also on account of 
its slow elimination from the kidneys, while other gravel- 
forming substances are often eliminated in large quantities at 
a time; e. g., uric acid and the urates, phosphates, oxalate of 
lime and carbonate of lime. 

"Cystin does not pass into the tissues, except in solution. 
The cystin that appears in the urine as crystals comes from the 
Malpighian bodies, but cystin in the urine generally occurs in 
the granular form. It can often be seen with the unaided 



148 



DIAGNOSIS BY MEANS OF THE BLOOD. 



eye. If very abundant, the urine may look milky. Seldom, 
even in bad cases, are heavy deposits found daily. 

"By 'cystinemia' is meant such a collection of this peculiar 
compound in the system as to produce any great disturbance 
of the body. This condition results in various forms of dis- 
ease. The formative departure is in the alimentary canal. 
Later on, the blood becomes thick and ropy. 

"Cystin may be excreted by any of the mucous surfaces, es- 
pecially the kidneys, the bronchial tubes and the epithelial 
surfaces of the bowels, but cystin in all these cases is always 
found in the blo^d, sometimes found in the urine, expectora- 
tion and the faeces. Its local manifestation is only a symptom 
of the systemic condition. 

"Cystinemia is apt to affect the nervous system, often pro- 
ducing great nervousness and also paralysis. It produces 
bronchial catarrh, and when affecting the smaller bronchial 
tubes produces asthma. 

"By reason of its production of thick and ropy blood it pro- 
duces rheumatism. 

"Cystinic rheumatism is more apt to enlarge the joints than 
any of the other varieties of rheumatism, owing to the in- 
solubility of cystin by the ordinary remedies given for the 
other forms of rheumatism. 

"Cystin produces a gouty condition of a chronic form. It 
does not produce acute rheumatism. Its presence in the blood 
is rarely absent at any examination of a marked case of this 
disease. Its presence in the urine is not constant even in bad 
cases, and probably this is why cystinemia is often overlooked 
by many physicians who seldom examine the urine of their 
patients and never examine their blood. 

"There seems in some cases to be occasional storms of 
elimination of cystin, either by the lungs or bronchial tubes, 
the bowels or the kidneys. Many times the urine becomes so 
loaded with cystin that the whole excretion will look like 
milk. This milky appearance is not caused by the hexagonal 
crystalline form of cystin, but the amorphous. 

"To prove that this granular matter is cystin and nothing 



FIBRIN-RHEUMATISM. 



149 



else, we have only to precipitate the amorphous to the typical 
form by the well-known reagents. These storms of elimina- 
tion or 'explosions' of cystin from the system are generally 
followed by a sense of relief to the patients, especially to those 
of a neurasthenic type. They experience in a degree a sort of 
temporary Men etre, yet they do not know why they feel better 
any more than some people do after a good cry and a liberal 
flow of tears. These persons seem to rival Mobe in their weep- 
ing, barring the difference in the cause. 

"When cystin attacks the epithelial surfaces of the bowels 
it often produces chronic diarrhea. Frequently there is pro- 
nounced dyspepsia — congestion of the portal system and dizzi- 
ness. Virchow found cystin in the liver. It has also been 
found in the lmyphatic glands and spleen. 

"In old times the iridescent pellicle of cystin, sometimes 
observed on the top of urine after standing a few hours, was 
regarded as a sign of pregnancy, but unfortunately for the 
theorist who started this notion, such a condition equally ob- 
tains in the urine of both sexes. The neurasthenic type of 
cystinemia is often called hysteria for want of a better name, 
but men have hysteria is well as women from cystinemia. 

"In the asthma produced by cystin the crystals are often 
dark, like coal dust, but the proof that these crystals are not 
coal dust is the fact that they are largely found within the 
cells of the epithelial surfaces. The condition constitutes 
gravel of the lung. 

"Cells do not take up solids except in minute forms, e. g., 
emulsified fats. Moreover, in cystinic asthma the blood al- 
ways, and often the urine, shows plainly the cystinic condi- 
tion at the bottom of the trouble. 

"In spermatorrhea, uterine and vaginal catarrh, cystin 
often appears. For the two latter conditions curetting and 
douches give only temporary relief. This leakage and catarrh 
returns and persists till normal digestion and metabolism is 
restored. Treat the patient's systemic condition, and the little 
side issues take care of themselves. Palliative treatment is all 
right, but it never removes causes. Although cystin contains 



150 



DIAGNOSIS BY MEANS OF THE BLOOD 



25% sulphur, the writer has not observed that the giving of 
sulphur by itself, or as it exists in certain foods, has anything 
to do with the production of cystin. It is, however, a fact that 
foods rich in sulphur often disagree with persons having cys- 
tinemia, e. g., they will observe that eggs and fish, both rich 
in sulphur, aggravate their subjective symptoms." 

From this pathology it will be seen that rheumatism should 
not be considered an acute disease, having a limited and defi- 
nite time to run. Tt should be treated with the intention of 
getting these crystals out of the system and reducing the 
amount and thickness of the fibrin. In order to do this, one 
must know what kind of crystals are in the system. To go 
into the details of this is beyond the limit of this work, but the 
stages of recovery in one case is here shown by means of pho- 
tographic illustrations. It will be noticed that the thickness 
or adhesiveness of the blood cells decreases as the fibrin and 
crystals leave. Fig. 47. It is a picture of the blood of a woman 
65 years old, who came to me not only with rheumatism but 
diabetes. Her prominent symptoms were stiffness and numb- 
ness of the toes and fingers, together with distress in the stom- 
ach. Fig. 48 shows the blood after one month's treatment. 
She said the numbness in the toes left slowly, but steadily, 
and one day when bathing her feet it went altogether. It has 
never returned up to this time. It will thus be seen that the 
effect of remedies can be watched by the blood examination 
when its pathology is properly understood. 

In closing this subject, which has been only lightly consid- 
ered, it must be evident that this should open a new line of 
thought. With these facts before us, how can the germ 
theory of this disease ever be considered? It is much talked 
about, but it cannot be thought that it will bear close inspec- 
tion. 

Note. — Rheumatism has been known by physicians for 
many years to be a precursor, "forerunner, advance scout," of 
cardiac lesions. Therefore, the photographs of heart disease 
will follow in this section, for these demonstrate that the con- 
stituents of vegetations on the valves of the heart exist in the 
blood long before, as well as after, the disease is well seated. 



FIBRIN- RHEUMATISM. 



151 



CASE I. 

Fig. 45 and Fig. 46 illustrate the rheumatic arrangement of 
the cells, and also the thick fibrin under a high power. 
' Dr. Wm. H. Katzenbach was called in consultation in this 
case, and it seemed to be a peculiar form of paralysis. The 
man was taken suddenly, but recovered partially, and finally 
died by degrees one year after the first attack. The rheuma- 
tism was in the blood, but showed itself in the usual way very 
slightly during life. 

CASE II. 

Some years ago I was treating a patient about 55 years old 
for rheumatism, together with the premonitory symptoms of 
apoplexy and paralysis. The pain in the joints was of an ach- 
ing character, and limbs were getting more stiff. It was appar- 
ently getting to be a case of arthritis. The patient got so bad 
after a time that confinement to the house, and even bed, was 
necessary. The heart was subject to palpitation, yet I could 
find no lesions there. 

We finally decided to call Dr. Alfred L. Loomis to see the 
case. Dr. Loomis came and made one of those brilliant diag- 
noses — such as have made him famous. He said the patient 
would live — though she was very low — and that "there were 
fibrin filaments passing through the valves of the heart." 

How many men could have made such a diagnosis? How 
many men have had the ear to hear? I remembered the words 
well, for I had previously examined the blood, found the fila- 
ments of fibrin greatly thickened and elongated, and I now re- 
produce them here. Fig. 49. Dr. Loomis knew not of my 
work, nor did I inform him. The patient lived, got well, and 
there was no cardiac lesion perceptible to others. 

The fibrin skeins are readily seen. The cells of the blood 
are dry and thus the fibrin skeins appear more massed than is 
usual. 



152 



DIAGNOSIS BY MEANS OF THE BLOOD. 



CASE III. 

Some weeks ago I examined the blood of Miss Sadie Mar- 
tinot, the actress. I casually showed her the photograph of 
Max O'Rell's blood, brought to me for the purpose of photo- 
graphing it by his physician, Dr. J. W. Moore. Miss M. said: 
"Now, if you ever publish that, just place mine along side of 
his (I met him in Paris some years ago), and say that this is 
Max O'Rell's and that Sadie Martinot's. 

The blood of Miss Martinot contains the crystals of cystin, 
showing the incipient stage of cystinic rheumatism. Fig. 50. 

Max O'Eell's, at this time, shows the healthy arrangement 
that his physical appearance indicated. Fig. 51. 

The photo-micrograph was taken with a Tolles one-sixth 
objective, non-photographic, and, hence, presents a very flat 
field. 



Fig. 41. — 1-6 obj. Normal fibrin. 




Fig. 43.— 1-12 obj. and low eye piece. Rheumatic fibrin somewhat broken. 




Fig. 45.— Case I. Fibrin 1-25 Tolles obj. 




Fig. 46.- Case I. Fibrin 1-25 Tolles obj. 
157 




Fig. 47. — Rheumatic arrangement of the red cells at the height of the disease. 
Very adhesive. For description see page 150. 




Fig. 48. — Same as Fig. 47, improved condition of the patient. Less adhesiveness of 
the cells. For description see page 150. 

159 



Fig. 49.— 1-12 obj., Case II. Fibrin skeins after standing some hours. 




Fig. 50.— 1-G obj., 4 ocul. Cystin crystals— Sadie Martinot. 




CRYSTALS IN THE BLOOD. 



Crystals in the blood have been so little known that it was 
thought best to illustrate with many photo-micrographs. It 
will thus impress the physician with the reality of such in 
the blood. 



167 




Fig. 53. — Crystals of triple phosphates in fresh rheumatic blood. 
169 




Fig. 55.— Triangular crystal at the top. May have come from the skin. 

171 




Fig. 57.— 1-12 obj. Large uric acid crystals. They are somewhat distorted, which is 

due to the lens. 

173 



Fig. 58. — Cystin crystals in urine. 




Fig. 59. — 1-9 obj. Cystin crystals in the blood. Taken from case 
of cystinic rheumatism. These crystals are very readily seen but 
more often not as perfect ; generally they look like broken glass. 
They are very hard and insoluble and are often the cause of brain 
lesions in rheumatics. 

175 



Fig. 60. — Broken .<rlass crystals of cystin. 




Fig. 61. — A very uncommon form of uric acid crystals in the centre of the field. 



EMBOLUS. 

(CLOTS.) 



Under this heading (of embolus) are included cardiac 
disease, apoplexy and paralysis'. 



181 



EMBOLISM AND ITS FACTORS. 



It is important that this chapter follow the preceding, for 
not only is this coagulation of blood in the system the pre- 
cursor of most paralyses and apoplexies, but it is preceded by 
one at least of the various kinds of rheumatism. These rheu- 
matic conditions may, therefore, be considered from a blood 
standpoint as first cousins to heart disease and those diseases 
mentioned on preceding pages. 

Many and long articles on the cause and composition of 
clots in the human economy could not only be written here, 
but quotations of the analyses of thrombi could be made from 
Virchow and other like authorities of equal rank, but of more 
recent date. All text-books contain similar analyses, for these 
emboli (clots) have been found postmortem for years. There- 
fore, all are agreed as to their composition. It is only of late 
that any of these constituents have been recognized in the liv- 
ing blood; they have been seen, but not recognized, and there 
is a great difference between the two words. I once knew a 
plumber who undertook a job all others had failed to do. 
When the work was completed his bill was $50 for half an 
hour's work; this being disputed, he itemized it thus: Five dol- 
lars for the work, and forty-five for knowing how (recogniz- 
ing). It was then promptly paid, for the debtor readily saw 
the difference between the man who recognized the trouble 
and the one who merely saw the pipes. I shall quote briefly 
what has been seen, and leave the constituents of these clots — 
the knowledge of which is common property — to be recognized 
in the photographs. 

The writer has tried to impress upon the mind of the reader 
that in all cases here considered he has invariably been pres- 
ent at the bedside of the patient. 

At the French Congress of Internal Medicine, held at Nancy, 
August 6-10, 1896, Professor Mayet said:* "Cases are met 
among chlorotic subjects in which thrombosis (clots) is due to a 
primary lesion of the blood, and accessorily to a disturbance in 
nutrition of the wall of the vessel. The reasons of this are 
manifold in chlorosis. In fact, the blood is richer in fibrin, as 



* See Bibliography. 



183 



184 



DIAGNOSIS BY MEANS OF THE BLOOD. 



the researches of Becquerel and Rodier and Andral have shown. 
Hayem's views to the contrary, notwithstanding." This is a 
disease in which there is generally an excess of leucocytes, as 
well as a diminution of haemoglobin. A photograph on an- 
other page will show the fibrin as it is being formed from the 
leucoyte (Fig. 93). From this same article many similar 
opinions might be quoted as to the cause of these clots, but we 
are dealing only with the fact that they can be seen in a drop 
of the living blood. In the same article, Dr. H. Vaquez says: 

"Some investigators have shown, on the other hand, that in- 
jections of various substances facilitate coagulation of the 
blood, whereas others retard it, for a longer or shorter period." 
His article further says: 

*"Jones, followed by Zahn, showed that the clot was 
formed not by successive deposits of fibrin, but by accumula- 
tion and conglutination of the leucocytes. The role of leuco- 
cytes in the phenomena of intravascular coagulation is, there- 
fore, a very important one. Examined at its beginning, the 
thrombus is found to be formed by an accumulation of leuco- 
cytes surrounded by a fibrous substance, which is first loose, 
but gradually becomes firmer. In the midst of this light tissue 
of fibrin, one finds at points where the fibrinous meshes meet, 
granulations (rosettes of Ranvier). There are few red cor- 
puscles, which subsequently increase in numbers. The latter 
appear to be of slight importance, but it is otherwise with the 
fibrin. Ranvier's granules are small masses of fibrin, probably 
pre-existing in the blood, and becoming centres of coagula- 
tion in the same manner as a sodium crystal put into a solu- 
tion of the same salt becomes the starting point of crystalliza- 
tion. Hayem has described these bodies as hematoblasts, 
whereas Bizzozero, Eberth and Schimmelbusch have adopted 
the term blood plates. They are seen and described already in 
1845 by Donne under the name of globulins. It appears to 
be admitted by all hands that they exist before the formation 
of the thrombus, because Hayem, Bizzozero and others have 
found Ranvier granules in the blood in circulation." 



* See Bibliography. 



EMBOLISM AND ITS FACTORS. 



185 



These facts have been determined by examining the clot 
after death. That this primary lesion is "of the blood," that 
the blood is "richer in fibrin," that it is formed by "accumula- 
tion and conglutination of leucocytes, the "granules of Ban- 
vier," and, he might as well say, various crystals. These in- 
gredients, we repeat, have all been found by examining the 
clots after death. And these parts of a clot, embolus, thrombus, 
infarction have been known for many years, and it never occurred 
to these men to look in a drop of blood taken from a living subject 
to see these very same things. They are all there, and it only re- 
mains for me to point them out in the photo-micrographs which 
follow. 

The white blood cell forms the fibrin — that is one of its 
functions — one performing this function is shown in Fig. 93. 
And so, of course, there would be many in the clot spoken of 
previously by Dr. Vaquez. The granules of Eanvier are the 
tuberculous granules or the tuberculous matter in a small 
quantity which is described under the head of tuberculosis in 
this work. A photograph of a mass entangled in a long fibrin 
skein is shown in Fig. 68. It was taken from the system of a 
living man. This fibrin skein circulates through the blood as 
a comet courses through the solar system. If the man does 
not improve in health it grows and finally lodges in some ves- 
sel which it plugs and shuts off the circulation in that part. In 
this case, it stopped in the brain of a man in the night, and he 
never woke to know what killed him. The fibrin which in 
these conditions forms in long skeins in the blood vessel has 
been there long before the clot that produces the disastrous 
result is formed. This fibrin skein in the blood of the living 
man grows in length and thickness day by day and year by 
year. It entangles crystals, tuberculous granules, fatty 
leucocytes, and whatever foreign matter may be in the vas- 
cular system. This in time produces vegetations on the valves 
of the heart (traveling clots), and the various conditions men- 
tioned above are produced, which so often in the past have 
rendered necessary a necropsy in order to find out the cause of 
death. In the case mentioned, the man never had rheumatism 



186 DIAGNOSIS BY MEANS OF THE BLOOD. 

of the joints. He was never sick very much, but as a rule in 
such cases the subjects suffer from vertigo, ringing in the ears, 
and slight stomach trouble as precursors. 

These things are shown in the photographs following. Por- 
tions of them, and often the whole of a small clot can be seen 
with a microscope in a drop of blood in the living man. 

Dr. Vaquez is quoted as saying that there are solutions 
which render the blood either thick or thin. Many have no- 
ticed this. Magendie, who lectured in the College of France 
in 1839, knew this, and he thus speaks of one Kuysch, who had 
discovered and used a fluid, which he injected into the circu- 
lating system of his patients, and which was perfectly 
mixable with the blood, Magendie says in regard to him : 

*"I cannot allow the opportunity to pass without expressing 
my disapprobation of the narrow-minded selfishness evinced by 
the anatomist just named in carrying his secret with him to 
the grave, after he had turned it to the best pecuniary account 
during life. The loss is one much to be regretted. Who knows 
but that, had we been acquainted with the composition of the 
fluid he employed, we might have under various circumstances 
been enabled to modify the blood beneficially for our patients, 
to restore it some of the properties it might have lost, or given 
it new ones." 

Magendie speaks of the viscidity of the blood and of the va- 
rious injections that modify it. It may be that this solution 
which Ruysch was using was for the purpose of modifying 
these clots. Magendie does not say so, but he seems to imply 
it, for he himself experimented with various solutions that 
modify the consistency of the blood. 

CASE I. 

The oblong rope-like mass of cells shown in this photograph 
(Fig. 62) is an embolus, or clot, from a child 10 years old, who 
had rheumatism of the heart. The attack began in the joints 
and went to the heart in a very short time, producing death. 
This clot was in the drop taken ten hours before collapse oc- 



*See Bibliography. 



EMBOLISM AND ITS FACTORS. 



187 



curred. You will be able to make out the red and white cells 
entwined and bound together by the fibrin skeins. It has long 
been known and is recorded in most modern text-books that 
such clots are found at the autopsy (see Green's Pathology, 
p. 55). With such photographs as are shown here and on suc- 
ceeding pages it is useless to say that these can just as well be 
seen before death. It has always seemed strange to me that 
so few records have been made of the fact before, for this cer- 
tainly is a symptom of the symptom." 

This child suffered severe pain before she died. My brother, 
who saw the patient, said the case was complicated with 
pericarditis. I applied various reagents to this clot 
under the microscope. A salt solution was tried first with 
no effect. A strong potash solution was then tried on another 
specimen. This dissolved everything in sight. Among other 
solutions of no avail tr. digitalis was tried, solution of 
strychnine 1-50 gr. in a hypodermic syringeful of water, dilute 
solution of muriatic acid, the vegetable acetic acid and also 
others. All caused no change of any moment. I finally added a 
solution of sodium chlorid and sodium bicarbonate, and the 
cells in this cut separated from each other and let the skeins 
of fibrin to themselves. This fibrin I noticed was also somewhat 
diminished in size, i. e., the skeins were partially dissolved by 
the use of the sodium bicarbonate alone. I would produce 
the photographs then taken with the 1-7 Leitz obj., if the 
fibrin skeins were not so fine that a half-tone would not show 
them to good advantage. 

With such facts, is it any wonder that the alkaline treat- 
ment is of benefit in these cases? In Sir Benjamin Ward 
Kichardson's work, "Vita Medica,"* which gives the result of 
some of his experiences and observations in a practice of 50 
years, he alludes to the treatment of emboli which lodged in 
the right heart of several of his patients, and its removal with 
doses of strong ammonia. His method was to give the am- 
monia in milk — I have forgotten the dose, but I know he gave 
large quantities of it. I recollect that he was called to a 



* See Bibliography. 



188 



DIAGNOSIS BY MEANS OF THE BLOOD. 



woman with a fibrous embolus in the right heart. He said he 
gave "milk and ammonia until she smelt of it." He relates 
several cases and under this treatment they all recovered. The 
book is well worth reading, and may suggest something in the 
remedial line of life-saving value. It was the alkali separating 
the cells from and partially dissolving the fibrin that saved his 
patients. 

CASE II. 

The next case illustrates the embolic fibrin separated from 
the cells as occurring in a patient with rheumatism compli- 
cated with heart disease. Fig. 63. When seen among the 
blood cells the fibrin reminds one of a comet in the heavens 
floating amongst the nebulous stars. The patient was very 
much crippled with rheumatism when first seen, but she made 
a good recovery. 

PARALYSIS. 
CASE III. 

Mrs. D., 75 years old, was suddenly attacked with vertigo at 
the dinner table in July, 1896. I attended her until her physi- 
cian, Dr. Daniel M. Stimson, arrived. An examination of the 
blood revealed the long skein of fibrin seen on the opposite 
page, thus showing that she had emboli (clots) floating in her 
system. One year later she died suddenly of heart disease. 
This is another illustration given to show that these fibrin 
skeins are an accompaniment of cardiac lesions. Fig. 64. 

I remember another woman over 80, who had exactly the 
same symptoms as the one above, only more severe and of 
longer duration. (No picture is shown.) The former was 
affected the first time only a day or two while the latter was 
in bed several weeks. Dr. George Van Schaick was the family 
physician, and will remember her, for the doctor thinks the 
woman's age is nearer a hundred than eighty. 

The examination of the blood revealed none of those skeins; 
in fact, the fibrin was normal. She made a good recovery, and 
is living to-day (and this was two years ago). The trouble 
in this case was in the stomach. 



EMBOLISM AND ITS FACTORS. 



189 



COW'S BLOOD. 
CASE IV. 

Here is also shown the pictures of an embolus (clot) in a 
cow's blood. The blood of a cow looks like that of a human 
being, the cell, however, being a little smaller. Figs. 65-66. 

This photograph was obtained during my vacation one 
summer from a cow on a stock farm. Two years after I met 
the overseer of this farm and inquired about this cow, for 
records of her history were kept for some time. Several photo- 
graphs had been taken. He said that one day this cow turned 
around in its stall a few times, as if dizzy, and then dropped 
dead. 

CASE V. 

Rare, indeed, is it to obtain specimens of blood with the 
fibrin network intact. No stain has yet been found to prove 
even its existence, so elastic and so changeable are its fibres 
when exposed to the light. But as we were going to press a 
patient came in with a rare form of paralysis, the main symp- 
tom of which was inability to control his head. He had to 
hold it forward by placing his hand on his jaw. He was a 
most pitiable sight, for he was only 24 years old, tall and hand- 
some. If he let go, his head fell back and his face assumed a 
horizontal position. It was a tiresome position, and he was 
rapidly becoming very weak. He had not been out before for 
two months. He was sent to me for examination by his physi- 
cian. 

The first drop of blood taken is reproduced here. Fig. 67. 
The thickened fibrin network of the blood is shown as it ac- 
tually existed in his system. In its normal condition, this lat- 
tice work is smaller and the lines finer than in this specimen, 
and it reminds one of a fisherman's net floating on the surface 
of the water. So this fibrin network floats in the blood, and 
the corpuscles occasionally pass through the meshes back and 
forth as this cylindrical net is lazily suspended in the plasma 
of this colored river of the system. 



190 



DIAGNOSIS BY MEANS OF THE BLOOD. 



As is already perceived, this fibrin is a normal ingredient, 
aye, one of the factors of the blood. It is really a tissue, an 
organ, which has a function to perform, and that function is 
interfered with when these filaments become thickened, and 
bile, salts or other crystals entangle themselves in its delicate 
tissue. A great deal of pathology to-day can be explained by 
giving this fibrin its proper pathologic importance. 

So, in this man's blood we have what looks like a cast of the 
fibrin. In reality, it is an infarction which has clogged up a 
vessel and produces his paralysis. It is a microscopic throm- 
bus, and is associated with rheumatic blood. He had been 
told that his trouble was due to syphilis; on being informed 
that this disease was not in his system, his reply showed his 
appreciation, since he said that fact alone paid him for coming 
from a distant city. 

The treatment of this case should be on the same principle 
as that of an embolus, for this is a similar condition, only 
slower in producing its effects. Sir Benjamin Eichardson's 
plan, i. e., the use of alkalies, ought to work well here, together 
with massage and electricity properly applied. 



Fig. 62. — Rope-like appearance of the embolus (clot) is easily seen, the black spots 
show where the cells are matted together in spots. 




Fig. 63.— Embolic fibrin with the corpuscles washed away with water. 




Fig. 64. — Fibrin skein between the corpuscles. 




J 
I 



Fir. 65.— Cow's blood. 




Fig. GT. — Network of fibrin. 





Lizard's blood, 1-12 obj. The nucleus of the red cell in the lizard becomes in time the 
white blood cell: in man it is the reverse. 

201 



CARDIAC DISEASE. 



HEART DISEASE — RECOVERY. 
CASE I. 

The accompanying photographs are taken of the blood of a 
girl 11 years old, who was taken suddenly with shortness of 
breath, pain over the heart, and fever, and became so weak 
that confinement to her bed was the only thing possible. It 
was no doubt a case of endocarditis with rheumatism. The 
pain and fever came suddenly, and there was a distinct mur- 
mur over the left heart, a mitral regurgitation. This got worse 
for some days. Dr. George E. Doty saw the case with me, 
and treated her a few days while I went to the country. See 
Figs. 69, 70, 71, 72. 

You will note the ropy red cells and the large number of 
white corpuscles, together with the long fibrin in some spots. 
An ulcerath T e process was evidently in progress. After three 
weeks she began to get better, and to-day is practically well. 
She is now 16 years of age. There is no cardiac lesion percepti- 
ble. The photograph (Fig. 73) was taken recently, and shows 
the return to a more healthy condition of the blood, as well as 
of the individual. She is now the picture of health. This was 
a plain case of heart disease with recovery. 

CASE II. 

This last figure, 74, represents the blood of a banker, 28 
years old, of very healthy appearance. The valvular sounds 
were very loud and audible all over the front of the chest and 
in the back. The fibrin skein here is very distinct. This is a 
good illustration of the fact that a young man can be appar- 
ently well and strong with a grave disorder, the lesion of 
which may be recognizable both by the blood and the usual 
physical signs. Often the blood of such persons contains crys- 
tals, and again fat globules within a swollen white blood cell. 
When these deposit in the heart year after year and a little 
at a time, after they have existed there for years, they are 
called vegetations. These sometimes break off and go to distant 
parts and cause paralysis. It is thought by some that they are 
only on the valves of the heart, but I am glad to point out that 
they are also in the blood stream, as here and elsewhere stated. 

205 



Case I, page 205. 

Fig. TO.— Nole the leucocytes, the character of the fibrin and the clumping- of the 

red cells. 




Case I, page 205. 
Fig. 71. — Another view of the leukocytosis. 

207 



Case I, page 205. 

Fig. 72. — 1-6 obj. Showing the tubercular matter that is often present in these lesions. 




Fig. 73. Same as Figs. 70, 71 and 72, after several years — recovery. 




Fig. 75. — Long skein of fibrin, crystals and foreign matter, could easily form an embolus. 

(No text.) 





Fig. 78.— Case examined for Dr. F. E. Miller (no text). Mitral regurgitation and aortic 
stenosis, showing the fibrin skeins. 

215 



MENINGITIS. 



The two cases here considered were taken in the alcoholic 
ward of Bellevue Hospital by permission of Dr. Chas. L. Dana. 



219 



MENINGITIS. 



I do not know that this specimen of blood is characteristic 
of alcoholism, but it was taken from a patient in the alcoholic 
wards of Bellevue Hospital. The man said that he had been 
drunk every Saturday night since he was 15 years old. 

It will be seen here that the corpuscles are all broken up, 
and it is a fact they are rotten, for they are apparently filled 
with little holes and there was scarcely any color in the cells. 
This, as usual, was a fresh specimen. (The streak in the lower 
border of Fig. 79, is a tear in the film of the negative.) Such 
patients we all know are often taken off with pneumonia, but 
this man (Fig. 79) died of tuberculous meningitis. I say tuber- 
culous, for there is tuberculous matter visible in the photo- 
graphs (Figs. 79 and 80). They were taken under the service 
of Dr. Chas. L. Dana. 

It will be seen from these two photographs, as was pointed 
out under unhealthy blood, that it is not requisite for the 
blood to be agglomerated or adhesive in order to be un- 
healthy. 

It will be noticed that while the blood cells are evenly dis- 
tributed in the first photograph, in the second this is not true. 
From what has been learned in previous pages, it will, there- 
fore, be seen that from the blood standpoint, the man from 
whom the second picture was taken suffered from some form 
of rheumatism, but this is not true in the first case. 

It is well to call attention once more to the fact that several 
fields of the specimen should be examined in order to get an 
average of the general appearance of the blood. 

It will be noticed also, in Fig. 80, that the fibrin is very pret- 
tily shown. It can be seen that, naturally, the fibrin here is 
long and thick, but actually it is broken in spots, thus show- 
ing that, if not his constitution, something is shattered. 

221 



Fig. 79. — Meningitis — alcoholic. 




McKINLEY'S CASE. 



McKINLEY'S CASE. 



227 



THE EXAMINATION OF THE BLOOD IN PRESIDENT 
M'KINLEY'S CASE. 

By the death of President McKinley, on September 14th last, 
the nation has lost a man whose inner life was little under- 
stood or appreciated by the vast majority, even of those who 
respected him and thought that he never erred. 

While it may seem strange to many that his name should 
be mentioned in a work of this kind, on reconsidering, it will 
be remembered that the consulting physicians submitted his 
blood to a miscroscopic examination. 

At the time of Garfield's assassination, the examination of 
blood was not much thought of. In the past few years, how- 
ever, this line of work has made great strides; and blood ex- 
amination to-day is carried on systematically in every large 
hospital. 

The question naturally arises: What could have been indi- 
cated by the blood in the President's case that would in any 
way have been of value? 

Theoretically, everything should be told, while practically 
a blood examination is of more service than would be im- 
agined by those who are not familiar with this line of work. 

The statement made in another part of this work is appli- 
cable here, that when one part of the body is "sick" the whole 
suffers with it. An experienced diagnostician, by means of 
the blood alone, can often tell when parts of the body are 
"sick." The condition may be recent, or it may have been 
coming on for years. 

I say the blood will often tell the inner story; as the old 
quotation says: "Every action of our lives touches on some 
chord that will vibrate in eternity." 

So, to a greater or less degree, every action makes some 
change in the body. There may be no practical way of deter- 
mining the finer effects; but if a definite action of mind or 



228 



DIAGNOSIS BY MEANS OF THE BLOOD. 



body is kept up, in time the change is perceptible to the eye. 
And so, for health or disease, this change takes place, and 
sometimes it is years in showing evidence. This evidence to- 
day can be seen by one experienced in blood diagnosis. For 
example, gangrene will show changes in the blood, and the 
physicians resorted to a blood examination in the President's 
case. 

Both a fresh and a dry blood examination should always 
be made if everything is expected to be found that is deter- 
minable by this diagnostic method. 

William McKinley, like all public men, was cartooned, criti- 
cised and misrepresented for years, even by many who now 
see their mistake. All men who have a conscience are aware 
that much criticism on a sensitive man is not only wearing, 
but when joined with the great weight that falls on our Chief 
Executive, from such sources, would rip the very nervous 
tissue — say nothing of the nervous energy — in a man of Mc- 
Kinley's sensitive parts. 

And such changes can be seen in a fresh or living blood ex- 
amination. The poikilocytes and the microcytes, either one 
or both together, might be present in the blood. When such 
changes take place in the nerve elements, the blood corpuscles 
have not their proper form; they should all be round and elas- 
tic, but instead they are elongated, angular and flabby, and 
often the number of dwarf cells are increased because the sys- 
tem does not have time to manufacture strong, full-sized 
cells. 

The nervous energy is used up too fast, and this latter condi- 
tion is especially perceptible to the diagnostician when the 
crenated red cells are abundant. These cells can be seen easily 
in the fresh blood, and that there be no mistake as to what is 
meant by fresh or living blood, we refer the reader to the in- 
troduction. Of course, if the blood stands half an hour or so, 
all the cells get more or less crenated. But they should be 



McKINLEY'S CASE. 



229 



seen floating around in the serum as soon as the drop is placed 
on the slide see Fig. 93. That then indicates the condition of 
the system. Fig. 81 illustrates it well. 

These things that have been pointed out are seldom thought 
of by the majority of blood examiners. More often, an in- 
crease in the number of white cells is what is looked for. Nor- 
mally, there is one to about every four hundred red ones; but, 
as a rule, these are counted by the dry method of examination*. 
One examination by this latter method is often of no avail. In 
the President's case there were found, according to the physi- 
cians' report, 6,752 white and 3,920,000 to the cubic milli- 
metre of the red cells, which is below normal. In each it was 
expected that there would be an increase in these white cells, 
or more than normal. The only way for the dry method to be 
of any definite value would be by reference to a previous exam- 
ination. 

If the President six months before, or even a month before, 
had had his blood cells counted, a comparison of that condi- 
tion with the one at the time of his sickness would have been 
of some value one way or another. There will be a time when 
people will have their blood examined as regularly as they go, 
or ought to go, to their dentist. If a photograph is taken, there 
is a defienite record to look back to. 

Therefore, as it happened, the blood examination of the 
President threw no light on the case. 

The fresh blood examination, however, in the hands of a 
diagnostician — and every physician should be his own — should 
have at least revealed his weak condition — this lack of 
vitality. 

In President Garfield's case, if blood examinations had then 
been in vogue, it would have told much, but not without a pre- 
vious record (or a photograph) to compare. It was found at 



* Normally by this method there are 7.000 white and 5,000,000 red cells to the e.m.m. 



230 



DIAGNOSIS BY MEANS OF THE BLOOD. 



the autopsy that he had an abscess* cavity, which had noth- 
ing to do with the wound caused by the bullet. This, in itself, 
would show leucocytosis, or increase in the white cells. 

The pyemia, which afterward developed in Garfield's case, 
from the destruction of tissue, would have shown marked in- 
crease in the white blood cells, and probably much tubercular 
matter. 

This statement on McKinley's case from a blood standpoint 
is simply to show some things that all do not think of, and to 
indicate what often can be told from a fresh blood examina- 
tion, in contradistinction to the dry. 

It is not in any sense intended as a criticism. 
According to the report of the physicians, the President died 
directly as a result of the gunshot wound. 

When the nervous energy in a man is exhausted, the result 
is just as bad as though his blood vessels were empty. The 
preservation of the vitality in the human economy is to-day 
not appreciated by the majority of men and women. This 
energy can leak from its channels in the body in many ways, 
the same as steam can leak from the boiler or cylinder of the 
steam engine. If you shoot a boiler full of holes there will be 
no steam left to make the engine go; and so McKinley was 
shot, and his already weak vital system was drained still more 
(of energy). 

The fact that the bullet affected the pneumogastric-nerve 
and, perhaps, passed close to the solar plexus, is what did the 
damage. This, in itself, often kills. Pugilists are aware of 
this, and use a belt to guard this location. Attention enough is 
not given in our post-mortem examinations to the nervous 
tissues that are affected by shocks, due to either wounds or 
surgical operations. For when the nervous energy is low, or 
there is a great loss of blood, which is often dangerous; poikilo- 



* See Bibliography. 



McKINLEY'S CASE. 



231 



cytes or flabby red cells are often present in proportion to the 
weakness, and these cells would always be of great aid in diag- 
nosing this condition. 

The shock in this case dissipated what nervous force the 
President had left, by shutting off one of the main channels 
through which this energy travels in going from the head to 
the feet. This shock can be compared to the breaking or short- 
circuiting of the main wire of a dynanio-electric machine 
under full load. The result here would be the stopping of the 
machine. In the body, the only thing that could happen would 
be death of tissue, mortification or death of the man as a di- 
rect result of the shock. Again, often in connection with the 
nervous shock, the dwarf cells make their appearance in the 
blood and we have nerve weakness, indicated especially when 
these dwarf cells are mixed with the poikilocytes. In order to 
see these latter well, a large drop of blood must be had and the 
cover glass must be laid on gently, for the ability to perceive 
and judge this condition cannot be gained in a night; it can- 
not be learned in the laboratory; but the ability to see these 
peculiar red cells slowly floating about in the watery portion 
of the blood can only be learned at the bedside of the patient. 

When these two kinds of cells described are present in 
abundance, the blood supply is distributed slowly to any part 
because the heart action is weak. Death of tissue in this state 
of the system must result somewhere. When gangrene sets 
in, even in a moderate degree, there will generally be found an 
increase in the white blood cells. Germs of various kinds, 
tlien begin their work; if present, bacillus coli communis and 
gas germs, in connection with the others, call for more fuel; 
the continual lowering of the vitality allows the fuel to be sup- 
♦ plied; and so the germs multiply and gangrene goes on. 

President McKinley's death was due primarily to the gun- 
shot wound, and, secondarily, to the low state of his nervous 
energy. 



232 



DIAGNOSIS BY MEANS OF THE BLOOD. 



There have been only a few recoveries from similar wounds 
— such is never expected. Dr. Van Hoevenberg* reported since 
McKinley's death one such in a man aged 33. The young man 
was strong and vigorous, his vitality or nervous energy was 
high; he withstood the operation well, but possibly the ball 
did not strike in as vital a part as in the case of McKinley. 
Still, it is generally considered that bowel wounds, such as 
that reported by Dr. Van Hoevenberg, are the more dan- 
gerous. 

Still more plainly does this lack of vitality stamp its fatal 
mark when it is remembered that the President's whole body 
began to mortify in a very few days. This, again, will confirm 
the opinion that there was lack of vitality, due to the wound, 
and the long strain under which McKinley had been laboring. 

To some it will appear out of place, nevertheless medical 
periodicals throughout the country have been eulogizing 
President McKinley more or less. We therefore say, without 
fear of controversy, that William McKinley was one of the 
few modern public men that had lived and kneio how to die. 

He probably, for the time, saved the life of the man who 
slew him. "Be easy with him, boys." 

Plutarch says, when speaking of the personality of Phocion, 
the great Greek general : "That a word or a gesture from a 
truly good man carries more weight than ten thousand elo- 
quently argued speeches." 

And so in the President's last hours upon earth — just as 
natural as though he were going to live for twenty years to 
come — McKinley (as James G. Blaine said of Lincoln in his 
debates) said: "The things that would stand the test of time 
and square themselves with eternal justice," more truly and 
more as he lived, than any public man of whom we have 
record in modern days. 



* See Bibliography. 




Thick blood — No text. 



233 



1 



SYPHILIS 

(THE CRYPT A SYPHILITICA.) 



Iii considering the subject of syphilis, the history of it has 
not been gone into to the extent that I should have liked. 
Neither has it been dealt with in the preamble in the custom- 
ary way of approaching the description of a germ, but it has 
been dealt with in a way that would best suit the time. 



237 



PREAMBLE. 



It was about 1860 that Pasteur began to investigate germs 
as a cause of disease, but the idea of living organisms — minute 
forms in active motion — being the essential cause of syphilis— 
as according to Alhanasins Kircher (1659) they were of the 
pest — was advanced as early as the seventeenth century.* 

Syphilis is a very ancient disease.* It was known to the 
Chinese over 2,000 years ago, and in Italy during the war be- 
tween France and that country it is stated the disease was so 
contagious that it was taken by the slightest touch or even 
through the air. It came to America on the same ship that 
brought her discoverer, Columbus. In the fifteenth century it 
was epidemic in and about Italy;* indeed some claimed that 
it was infectious and that it could be taken both by contact 
and through the air, and hence it was considered contagious 
as well as infectious. In the next hundred years its viru- 
lence very much decreased, and to-day authorities affirm 
that it is only contracted by contact with a mucous surface 
either by an abrasion of the skin, or is transferred by inheri- 
tance "to the third and fourth generation." 

The above facts seem to prove that the disease becomes 
less and less virulent from generation to generation with the 
higher development of mankind. Education or evolution 
some day will at this rate do away with what was once con- 
sidered a most contagious and awful disease. 

There is no doubt that the disease in some persons and in 
some localities is more virulent than in other persons and in 
other localities. It is said that this disease, when contracted 
by our soldiers in the late war in Cuba and in the Philippines, 
resisted treatment most obstinately. This may have been 
due to lack of nourishment and lack of strength. This disease 
to-day is, in some cases, known to be self -eliminating. 

In about 1870, physicians began to look into the subject of 



* See Bibliography. 



239 



240 DIAGNOSIS BY MEANS OF THE BLOOD. 

germs in earnest and some have gone so far to-day as to claim 
that every disease has its germ. This idea has spread so fast 
that the diphtheria of the present day is not the same disease 
of a few years ago. Since the discovery of the Klebs-Loefler 
bacillus, in connection with diphtheria, according to the bac- 
teriologists, the physicians have a finer method of diagnosing 
that disease. By this germ the disease is recognized in its 
incipiency while the old "putrid sore throat" of our forefathers 
is still diphtheria in its severest form. A mild tonsilitis 
is to-day considered diphtheretic if the Klebs-Loefner bacillus 
is found to develop on the culture media which has been 
planted with the above inflammatory product. 

Diphtheria therefore is to-day more common because a 
method has been found for discovering it in its incipiency. 

Syphilis will also become apparently more common when 
the general practitioner and the medical profession have had 
the germ distinctly pointed out and when it is fully under- 
stood by them as well as by those who have made it a study 
because a finer diagnosis can then be made. It will then be 
seen in its travels from generation to generation, for in these 
cases its symptoms are often so mild that they are overlooked, 
and there are often no external symptoms whatever; the worst 
visual symptoms being sometimes the copper-colored eruption 
of the skin. 

In fact by its very symptoms to-day syphilis is considered by 
the best authors as a non-venereal* disease. This is due in a 
great measure to its being found by specialists to complicate 
many affections and thus it is traced by skin symptoms to be 
more common than formerly, and this opinion is confirmed by 
the quick response of the disease to treatment. 

And lastly, it is found to be contracted in so many different 
ways — from segars, instruments, kissing, closets, surgical 
operations, manufactories, etc. These things, together with 
the fact that age lessens the virulency of a disease, have 
tended to make this one more common. And syphilis being 
a chronic disease and of longer duration than an acute dis- 



* See Bibliography. 



SYPHILIS. 



241 



order (like diphtheria), has longer to remain latent and thus 
longer to become attenuated in the system. 

Syphilis, then, by the germ method of diagnosis is ap- 
parently more prevalent than formerly, because it is detected 
first in its incipiency and second in its inherited conditions 
and third in its latent state. 

Pasteur demonstrated that the inoculation of an animal 
and the re-inoculation of man with the same disease (hydropho 
bia) made the disease less virulent. Darwin says that "Man is 
liable to receive from the lower animals and to communicate 
to them certain diseases, such as hydrophobia, variola, the 
glanders, syphilis, cholera, herpes, etc." These facts again 
contribute to the decrease in the virulency of the disease. 

Leprosy, in Biblical times, was a much more severe disease 
than it is to-day. In chemistry at the present time it has been 
found that former supposed elementary bodies are composed 
of several elements — the latest report being that hydrogen 
is a compound body. And so applying this principle to 
medicine, it may be that syphilis is an off -shoot of leprosy. 

The destruction of its tissue is similar and much of its path- 
ology is like that of syphilis. 

Again, the spore of the bacillus stage of the syphilitic germ, 
as described in this book, resembles the bacillus of leprosy 
both in looks and size as it is described by others. As to other 
tests for the similarity of the two, I leave them to the bac- 
teriologists. These facts may indicate that the syphilis of to- 
day is cousin at least of leprosy. 

There is no doubt that there is a food in the system on which 
this germ of syphilis lives which is becoming gradually elimi- 
nated. This food we have not yet recognized, but the germ 
I think we have. 

Most of the recent literature on dry blood examinations has 
dealt on the subject of syphilis from the standpoint of cells. 
These writers seem to persist in the notion that syphilis pro- 
duces some form of change in the red or white blood cells. 
Others seem to think that they will find that syphilis produces 
changes that inlluence the number of red or white cells. 



242 



DIAGNOSIS BY MEANS OF THE BLOOD. 



While I would not discourage this kind of an investigation, 
I would not expect to find changes of this character, except 
in the advanced stages of the disease. Lostofer had this no- 
tion more than one hundred and fifty years ago, and the fact 
of his researches is recorded in "Ziemrnsen's Practice of Medi- 
cine." 

The germ of this disease, however, was discovered many 
years ago, and I shall proceed to describe it, for it is easy to 
see when the blood is freshly drawn. 



THE GERM OF SYPHILIS. 



The germ or plant that is found in this disease consists 
of three parts or stages of development. First, the spore. 
This is round and its diameter is about the diameter of the 
tubercle bacillus. It is of a dull red color and very lively for 
such a small object. It thus needs a one-twelfth objective, and 
unless one is accustomed to looking through the microscope, 
it may be difficult for such at first to see it, but if once seen 
and it is looked for often enough and long enough, it will be 
recognized always and then it is unmistakable. 

The spore is sometimes found in the red corpuscle, more 
often in the white, but mostly in the plasma of the blood. 
It is immobile occasionally in the red corpuscle — here in this 
state it is often mistaken for other things — it is here also in 
its mobile condition that several are sometimes found together 
swimming about, reminding one of a swarm of bees. In the 
former condition, they have been mistaken for the Plasmodium 
of Laveran, the accepted germ of malarial fever. 

In the white corpuscle also they are quite active — as much 
as the cell wall and their crowding together will permit. I 
show photographs of these small spores in a white corpuscle. 
Figs. 82-83. 

In the serum they jump about in the most wonderful man- 
ner; they have a jostling, irregular, spiral motion; but when 
many are present in the serum, they remind one in their mo- 
tion of a lot of small flies as they swim on the surface of a mill 
pond. 

The second stage of development, as it appears to be, is the 
bacillus of the same color and about three or four times the 
length of its diameter. It seems to have a glistening surface 
or membrane, as it refracts the light in its slower but some- 
times active movements. This is generally found in the serum 
— I have never recognized it anywhere else. It is not seen in 
all syphilitics. This bacillus appears to be similar to the de- 

* The syphilis spore is magnified over 5,000 times in a photo under the head of miscellaneous 
n the back of the book, Fig. 122. They are white, due to the high power, and are entangled in 
the fibrin. 

243 



244 



DIAGNOSIS BY MEANS OF THE BLOOD. 



Bcription of the bacillus of Lustgarten. It is to be regretted 
that there is no laboratory with facilities so that the identity 
of the two can be demonstrated. 

The third stage of development of this germ appears to 
be the filament discovered and demonstrated by Golosz, 
formerly of Vienna, now of Paris, where I met him in 1895. 
Jt resembles the cladothrix and can be seen best in the photo- 
graph presented to the writer by Golosz, when he was work- 
ing in Aubou's Clinic in the International Hospital, at Paris, 
and is here reproduced. His method of seeing it is by staining 
with methelyne blue, baking, etc. — a process too elaborate to 
describe here. It also can be seen without the stains, but it 
must be observed quickly as it does not keep. Golosz told 
the writer that the spore or bacillus was discovered by an 
American, but the name he did not mention. However, it ap- 
pears to be the mycelium of the crypta syphilitica.* I have 
been told that Hellier, of Jena, has demonstrated this spore, 
but after diligent search, failed to find anything he has writ- 
ten on the subject. However, it is this that I have described, 
have found and still find in all syphilitics. 
- Still, it may be said that I have seen two cases in which 
no form of the germ could be found; this must be extremely 
rare and I am inclined to think it was due to an oversight or 
to the treatment, as this latter would sometimes prevent ob- 
serving it. Still further, I have traced this disease by this 
spore through three generations, beginning with the grand- 
mother. The last in the chain was a young man, and he it may 
be well to record for the benefit of those who claim there can 
be no re-infection, contracted it in later life in the natural way 
and went through the various stages of chancre, eruption, etc. 
In this young man the bacillus or rod form of the germ was 
found at the time of re-infection. 

The trouble with most all the workers on this germ has been 
that they try to stain, heat or manipulate it too much. It is 
with little pains easily followed and seen in a fresh blood 
examination and in its natural growth. 

I have said that sometimes these little spores of syphilis are 



* See Bibliography. 



THE GERM OF SYPHILIS. 



245 



so numerous as to resemble small flies on the surface of a mill 
pond. Still again, one will see but one or two in the serum 
swimming about. After getting accustomed to their looks, 
they, in their solidity, remind one outside of the color of steel 
filings, so firm, solid and definite is their appearance. 

It's very strange how one can, by a slight twist, get entirely 
off the track of the original follower of a thing or principle. 
It is not always intentional, but in the case of this germ 1 
think it often has been. For example, to show how one can 
get entirely off the track in this work a friend and professor 
recently said in regard to the discussion at medical gatherings 
of a certain doctor: "I don't know what to make of him — he 
gets up and tells about finding cholesterine and yeast in the 
blood — why I defy anyone to find authority for such state- 
ments in any of my books," pointing to his library, "for I have 
all the works on that subject." The trouble here is the man 
was looking for authority instead of asking the doctor to show 
him what he saw. But my friend was not altogether at fault, 
for, to be frank, much of what has been written on the subject 
of fresh blood examination could be found to-day, but it is a 
mass of jumbled up literature; and this work, in a way, is in- 
tended to help at least unravel the tangle which has existed 
for many years. All the descriptions that I have seen in the 
past few years of any form of syphilis germ correspond as far 
as they go with some stage of the growth of the crypta syphil- 
tica. 

The latest description of a germ of syphilis of which I have 
seen record was given in a paper before the French Academy 
of Medicine by Drs. Justin de Lisle and Louis Jullien, and 
from the meagre descriptions that come to us, it would seem 
that this again is another imperfect description of this 
cryptogam — the crypta syphilitica.* Several have described 
this germ in the "Journal of Haematology" for April, 1901. 
Sternberg* also mentions it in the second edition of his work 
on bacteria. Hallier, of Jena, has seen and worked upon it. 
Many there are who have tried to claim this germ under a new 



* See Bibliography. 



246 



DIAGNOSIS BY MEANS OF THE BLOOD. 



name, but have failed. The spore of this germ is to-day ob- 
served and practically used by a great number of physicians 
whom I could mention, but who never refer to it outside of 
their own office. The Gonococcus of Neisser was described 
in 1868 by the same American genius who discovered this 
germ of syphilis and he called it the crypta gonorrhea, its 
proper scientific term. It has never been fully nor properly 
described since that date (1868) by any author. 

We have all heard of the borers (xglophagan) — a parasite 
which bores through the bark of a tree into its very substance. 
So this germ is the only one that infects the human body that 
is known to penetrate every organ. In its severe form and 
without treatment in a fit subject, "this spore starts from the 
skin or mucous membrane, and slowly journeys to connective 
tissue, muscle, liver, lung, spleen, brain and bone, deeper and 
deeper until no organ of the body is exempt from its ravages. 
To repeat, there is no other known germ that has such a wide 
distribution — always traveling in a regular order — often halt- 
ing for a while, but if unmolested its march is resumed. It is 
very rare indeed that tubercle shows such wide distribution 
in the body as this germ of syphilis." How strange when it 
responds so easily to timely treatment. 

Darwin says : "It is those who know little and not those who 
know much, who so positively assert that this or that problem 
will never be solved by science." And so those who have not 
seen this spore I advise to look for it. It will be found in 
the old man, it will be found in the middle-aged and it will be 
found in the blood of the new-born infant. 

To observe this germ one must be constantly changing the 
focus of the microscope. 

If this spore is not due to syphilis, my doubting friend, 
what is it? 

Until the author adopted the vitoscope to microscopic pho- 
tography, it was impossible to photograph this germ so that 
it could begin to be made plain to the student. Still it could 
be photographed, as is done in Fig. 83, which shows these 
spores in the white blood corpuscles. 



THE GERM OF SYPHILIS. 



247 



With the above machine called the micro-motoscope, (see 
last chapter), it is possible to throw perfect microscopic life 
on the screen. Such was done with this germ, but owing to 
che great expense it has not been done satisfactorily, notwith- 
standing it showed other microscopic life as clearly as one 
could wish. 

It is to be regretted that there is no laboratory in which 
this subject can be investigated more fully. Partly for this 
reason an exhaustive article on this subject has not been writ- 
ten and, if those who have the proper facilities have not time 
to follow this up, we shall be very glad to elucidate the sub- 
ject at length for their benefit at some future time. 

REMARKS. 

In recently developing syphilitics, I have often noticed 
great numbers of these spores both in the serum and in the 
leucocytes of the blood. As the patient gets under treatment 
they will be gradually noticed to diminish and finally disap- 
pear altogether. I consider it important to examine the 
blood when there is suspicion of syphilitic infection. If the 
spore is found the patient should be immediately placed under 
treatment, which is to be continued until the germ has disap- 
peared. The treatment should begin at once as soon as the 
germs are seen and there should be no waiting for the usual 
secondary symptoms. 

The germ then being of the type and character described it 
will be axiomatic, from what has been said in a previous 
article in this book — that the only proof that this germ is the 
cause of syphilis is on the same principle which the medi- 
cal profession accepted the Plasmodium of Laveran, (the germ 
of malarial fever as being its cause), which is by its constant 
presence in people known to suffer from this disease. 

Therefore, it falls in line to give illustrations of cases in 
which it has been found. The evidence is so conclusive, how- 
ever, in all such cases, that it seems to the author that one 
out of many hundred in his practice will be amply sufficient. 



248 



DIAGNOSIS BY MEANS OF THE BLOOD. 



Eight years ago a patient came to me saying that he had 
exposed himself to syphilis, and wanted to know if the sore 
he had was that of this disease. An examination of his blood 
revealed the syphilis germ. This, on being told to him, 
naturally kept him disturbed all that night. 

Not being so confident in those days of my diagnostic 
ability, 1 suggested that he go to a specialist, Dr. A., who after 
a careful examination said it was not syphilis. He went to 
Dr. S., of Boston, who confirmed this opinion. 

Below I copy a letter received from the gentleman two 
years ago to-day: 
''Dear Doctor: — 

"I hastily write concerning a very serious matter. I have 
a growth extending about half way down the side of my 

tongue, which Dr. B. says is tuberculous. Dr. M., of 

Medical College, made a microscopic examination of a section 
of the bunch and the result he found is the same. Saw Dr. 
T., of Boston, and he is convinced he can cure it without losing 
any of the tongue. Dr. B., who is a surgeon, says it should 
be cut off. I can't stop to write more details now. What I 
want to know is this: 

"Don't you think by internal treatment, etc., I can get over 
it? It is a very serious matter with me, you know, and if 
there is any way under heaven I can save my tongue, I am go- 
ing to do it. * * * I want you to give me your opinion 
as soon as you can. 

"Yours truly, 

"John S." 

This was in September, 1899. I replied reassuringly, tell- 
ing him to go to a doctor and be treated for the disease that 
his blood revealed several years ago. One week after the 
above letter, number two was received. 
"Dear Doctor: — 

"Was delighted to hear from you, and I find you are of the 
same opinion as Dr. W., who has made a specialty of bunches. 
He is in Cambridge. 

"He says it is a fibrous growth resulting from some injury 



THE GERM OF SYPHILIS. 



249 



influenced by the condition of the blood. He laughed at the 
idea of tuberculosis and is of the opinion that iny blood is in 
the condition you spoke of eight or nine years ago. So I am 
delighted to think I shall not resort to the knife. 

"I shall follow Dr. W.'s prescription. I do not see how Dr. 
R. and Dr. M., of College, could have made such a mis- 
take. If I had followed Dr. R.'s advice, I would have had my 
tongue cut out by this time. 1 am dreadfully glad to hear 
of your opinion. I think I am on the right track now. 

"Sincerely yours, 

"John S." 

Nothing more was heard from him, but while attending the 
musical convention at Worcester, Mass., in September, 1900, 
who should accost me in the aisle but this young man, looking 
more vigorous and stout than I had ever seen him. 

He said: "I was delighted to get your letter. I was treated 
for the disease you mentioned and began to improve right 
away. My tongue is all right and I guess I am. I tell you," 
he continued, "they told me in that college that I would have 
to lose my tongue." 



TESTIMONY. 

Desirous to know of others who had seen either form of this 
germ in this country, I began to inquire and look about, for 
my conviction from the first had been that it is a fact. But 
the attitude of the profession at large made me desirous of 
continuing my search, in the course of which, through Dr. J. 
S. Crane, I came in contact with Dr. John T. Metcalf, of New 
York, who was a man of uncommon intuitive diagnostic ability 
and an authority. He was at the time about seventy years 
old. I found him sick in bed with the gout. He, however, 
received me very kindly and my talk with him gave me re- 
newed confidence and encouragement. He told me that I 
might say in regard to this germ that never had he known it 



250 



DIAGNOSIS BY MEANS OF THE BLOOD. 



to be absent in syphilis. This was several years after it was 
pointed out to me.* 

My experience with the germ of inherited syphilis teaches 
me that it is almost impossible to remove it from the system. 
If a person has great vitality and uses it rightly, the chances 
are here better for its removal than in a person of low vitality 
or even in one of an inactive vitality, especially those who do 
not recuperate rapidly. In a person where the spores are in- 
herited, the chances are far less dangerous than where the 
disease is contracted. I really believe that now-a-days most 
eases of inherited syphilis pass through life without show- 
ing any special lesion and many times in the present day with- 
out shortening life in the least. It necessarily follows that 
the acquired disease is the one which manifests the lesions 
in the shortest time and in their severest form. It also is the 
form which responds most quickly to remedial measures and 
is the most easily cured. 



* See Bibliography. 




Fig. 83.— 1-12 obj. Crypta syphilitica in both white cells here. 
251 




Fig. 85. — Filament and bacilli (Golosz) mycelium or filament of crypta syphilitica. 

253 



MALARIA. 



If the reader wishes to follow the subject of Malaria, and 
the new mosquito theory of its propagation, I refer him to 
other works on that subject, many of which are obtainable. 



257 



1 



MALARIA. 



CASE I. 

In this photograph (Fig. 86) we have several stages of de- 
velopment of the malarial parasite, beginning with the un- 
pigmented hyaline body. The patient was under the in- 
fluence of quinine in Bellevue Hospital in 1894. The photo- 
micrograph is taken with a 1-25 Tolles objective, direct sun- 
light exposure and no stains. Other works on the blood deal 
with this subject quite extensively. 

There had been much work on the malarial parasites in the 
blood previous to the researches of Laveran; but my time has 
been so occupied with other investigations that little oppor- 
tunity has been devoted to the work of many good researches. 
I, however, ask your consideration of the photographs which 
follow. 

CASE II. 

This series of photographs was taken in Bellevue Hospital 
under the service of Dr. Charles L. Dana, in 1893. 

A man by the name of Wilson had malarial fever, and when 
the pictures were taken he was under the influence of quinine. 
It will be noted that the leucocyte here is undergoing 
great contortions in its evident struggle with the body in 
its grasp. All three photographs, showing the leucocyte 
in its different pugilistic positions, were taken within ten 
minutes of each other. The white cells of the blood have 
been called the policeman of the body because they carry off 
the germs. Many times in the past few years I have thought 
that this body was a red corpuscle instead of the Plasmodium. 

This idea had not occurred to me when in Paris in 1895 I 
then tried to see Laveran, the discoverer of the malarial germ, 
but he was absent from the city. Therefore I wrote to him and 
enclosed the photographs shown here. Figs. 88-89-90. In re- 
ply the following letter was received: 

259 



260 DIAGNOSIS BY MEANS OF THE BLOOD. 

t I ' f * 1 



[translation.] 

Paris, June 19, 1895. 

Very Honored Colleague : 

Not having had the pleasure of seeing you to-day and obliged as I am to set out 
again to-morrow morning, I send you herewith the photographs which you have 
kindly wished to show me. The haematozoa of malaria are hard to photograph, 
nevertheless one can obtain some images more clear than those which you have 
obtained. I regret very keenly not having been able to see you. I would have been 
ery happy to show you the photographs which I possess. 

Please accept the expression of my feelings very devotedly. 

A. Laveran. 




MALARIA. 



261 



I will, however, leave it to the judgment of the reader as to 
what this prisoner in the leucocyte is if not some form of the 
malaria germ. 

CASE III. 

The following letter from Dr. Hall, of London (who some 
years ago sent me some specimens of blood for examination), 
explains itself: 

3 Higher Mt. Gould Rd., Gold Coast Colony, 
Plymouth, Africa, Nov. 13, 1896. 

My Dear Dr. Watkins : 

I am afraid the specimens I send will not be of much service for the information 
they give. 

I received your answer just before leaving the Gold Coast, and as I was then 
doing district magistrate's duty, I had no time to see to this specially. 

I came away with^ only two specimens (a and b), from a negro suffering from a 
marked attack of malarial rheumatism. I am afraid that they will be spoilt by now. 

Specimens c, d, e are the cause of my sending the former, else I would not have 
troubled you. They are from three of my children, who were ill last week with 
epidemic influenza of a marked intermittent type. I send them as I found iu the 
garden a patch of ground, over which they play constantly on a balcony, giving off a 
most perceptible foetid odor from having been soaked for some weeks, I discovered, 
with odds and ends of kitchen refuse and kitchen " washing up water." 
r Specimen f is from myself, it being taken just before writing this. I am now 
eleven weeks from the tropics. I return again in March, and will make a proper 
series of such specimens if I hear from you that specimen (f)'is workable. Of course, 
if it be spoilt, it is not good to hope that good specimens could reach you from the 
longer distance. Yours truly, 

G. Rome Hall. 

In accordance with my directions the blood was mailed in 
small boxes filled with wet absorbent cotton. Around the 
whole was wrapped lead paper, such as comes on tea-chests. 
I received the package about six weeks from the time it was 
mailed. The blood was still moist, and Fig. 94 is that of the 
negro. It shows the arrangement of the cells characteristic 
of rheumatism, although the outline of the individual cor- 
puscles themselves has nearly disappeared. If one looks 
closely, a phosphatic crystal readily will be seen, indicating 
the form of rheumatism the man was suffering from. I did 
not see this myself until I examined the photograph for this 
work. I now see that there are several in the field. 



262 



DIAGNOSIS BY MEANS OF THE BLOOD. 



The other photograph (Fig. 95) shows the germs that were 
found in the childs' blood. It will be noted that it is filled 
with micrococci of some form. 

CASE IV. 

Fig. 91 is the Plasmodium of Laveran from a soldier in the 
Cuban War. The crescent is seen in one cell and the pig- 
ment in the other red corpuscle. 

CASE V. 

Fig. 92 is a specimen of fresh blood taken in my office in 
1896; this specimen is from the blood of a missionary who had 
been in the heart of Africa and there nearly died of the fever. 
The red cells are crenated and weak, showing a loss of their 
substance and great nerve depression. The large cell has a 
double contour, between which its granules or spores are seen, 
and is fairly well photographed. There is also apparent a 
large nucleus. 




Fig. 87. — Malaria. 1-12 obj. hyaline body. (No text.) 

263 




Case II, page 259. 
Fie. 89. — Ameboid leucocyte. 

265 




Case II, page 259. 
Fig. 90. — Ameboid leucocyte. 




in Santiago. (Two in the centre of field.) 



267 



Case V, page 262. 

Fig. 92 — Double contoured cell from young- man who had had the jungle fever in 
heart of Africa. Blood examined when he reached America. 





271 



WHITE BLOOD CELLS. 



HOW AND WHERE MANUFACTURED. 



Under this heading is considered the function of the white 
blood cell and a discussion of the present method of counting 
the leucocytes. 



LEUCOCYTES OE WHITE BLOOD CELLS. 



SYNOPSIS: 

MADE IN THE GLANDS. WHAT MAKES THE RED CORPUSCLES ? 

For many years it has been known that the leucocytes were 
manufactured in the spleen and other glands of the body, and 
secondly that the red corpuscles were a product of the white 
blood cells of the body. My observations and photo-micro- 
graphs for many years have demonstrated this fact, but only 
a few of the profession were aware of the simplicity of the 
spinning of the blood discs by the activity of the spleen. 

This process could easily be demonstrated on the screen 
with a little trouble to an audience of physicians by means 
of the micro-motoscope, probably showing the formation of 
the red corpuscles from beginning to end. 

To-day, by culling quotations from German and American 
authors, the above statements in regard to the formation of 
the blood cells are verified. 

Osier says that *"Lowit regards the lymph glands, spleen 
and bone marrow as blood forming organs," that "the nucleus 
of the leucoblast is relatively larger and contains one or more 
lumps of chromatin connected by radiating lines with the 
chromatin nuclear membrane." 

From my work and observations I judge that this latter 
quotation, translated into plain understandable English 
means — that the nucleus of the young white blood cells con- 
tains the red blood corpuscle together with its cell wall, or 
membrane, and its fibrin. 

The leucoblast is the young leucocyte, or white cell; the 
lumps of chromatin are the coloring matter of the red discs, 
the chromatin nuclear membrane is the cell wall of the red 
corpuscles, the radiating lines are the fibrin filaments of the 
blood, which are a part of the red corpuscles as well as the 
white, being much finer in the former. 



* See Bibliography. 



277 



278 



DIAGNOSIS BY MEANS OF THE BLOOD. 



It is claimed by some that the fibrin is spun out from or by 
the white blood cells, and that a portion of this goes to form 
the red blood corpuscle. This corresponds with the result of 
my work and is demonstrated in the star-shaped leucocyte, 
a photograph of which is given below. 

*"Foa and Salvioli believe that the nucleated red corpuscles 
are recruited continually from the giant cells." This, it will be 
seen, coincides with my previous statement that the red cells 
are manufactured from the white (giant-cells are white cor- 
puscles). Whether these red corpuscles have a nucleus or not 
makes no difference in regard to their place of formation. 
The nucleated red cells are nothing more or less than im- 
mature or malformed red cells. To complete the quotation: 
"Lowit believes that they (the nucleated red cells) are de- 
veloped from the erythroblasts (nucleated red corpuscles in 
embryo). Malassez, Osier and others take the same view." 
Howell says: "On the other hand, a number of investigators, 
while admitting the absence of the nucleated red corpuscles 
in the spleen under ordinary conditions, have nevertheless 
classified it with the lymph glands under the head of the 
hemato-poetic organs, because they hold that the colorless corpus- 
cles are formed, are produced, in this organ." 

As interpreted and understood these quotations seem to 
mean that we agree pretty well that all blood cells are formed 
in the glands, and that the red are formed from the white, as 
stated in the beginning. Fig. 93 shows the fibrin being manu- 
factured or spun by the leucocyte.* 

I reproduce here one of my many observations (Fig. 96), the 
presence of the red blood cells in the leucocyte. I will not try 
to call the leucocytes by any of the poly-names, for they are 
too confusing. 

There will no doubt be many views by those who observe the 
picture as to what it is. The nucleii were reddish and the white 
ameboid cell was very active. I thought at the time that it 
was a form of Plasmodium, for the man had malarial fever. 

Whether in this case these nucleii were due to a degenera- 



* See Bibliography. 



WHITE BLOOD CELLS. 



279 



tive change* or to a building-up process, I will not now dis- 
cuss. But it is observable that the blood was in a very bad 
condition. Concerning the name for the leucocyte and its 
.functions, as here illustrated, my opinion is stated above. De- 
cisions as to its accuracy will be left to the judgment of time. 

I also reproduce another leucocyte taken with a 1-25 Tolles 
objective, of a large red cell inside of the leucocyte. Some may 
think that this cell is over the leucocyte, but it is not. The red 
cell is within the leucocyte. Fig. 97. 



* In the spleen red corpuscles have been seen in various stages of disorganization: some of 
them lying with the substance of the large, colorless corpuscles, and, as it were, being eaten by 
them (Foster's Physiology, p. 36). 




Fig. 9".— Showing red blood cell actually in the white. See page 279. 
281 



LEUCOCYTOSIS. 



LEUCOCYTOSIS. 



It is well known that the number of leucocytes varies at 
different times in the same person and in the same disease. It 
is also well known that different observers do not count the 
same number of leucocytes at the same time in the same per- 
son. There are great variations, especially after a meal, and 
in many unaccountable ways. These facts being well known, 
I ask : Does it pay to spend so much time in counting the indi- 
vidual cells, as is the custom? I think not, and prefer to rely 
on the gross number found in one or two specimens, estimated 
by the unaided eye in a few seconds. One's judgment in the 
matter is practically of just as much value as a count. Es- 
pecially is this true for an examination of fresh blood. This is 
explained mathematically later on. 

To illustrate, Fig. 103 shows an increase of white cells. The 
patient had trouble about the mouth, either in the teeth or 
jaw. There are here approximately 15,000 leucocytes to the 
cubic millimeter. These white cells being nearly all lympho- 
cytes, you will look for abscess or pus formation, and in this 
case there was a small abscess about the teeth (pyorrhoea 
alveolaris). Fig. 104 would give a count of about 30,000; the 
location of the trouble is in the bowels, i. e., there is pain over 
appendix with a temperature of 101°. The leucocytes there 
fore, as a rule, will point toward free pus. 

There is nearly always an increase in the white cells in ab- 
scess of any variety. Another fact I have often observed is 
that tuberculous matter is always present in abscesses or pus 
formations, and hence an absence of the tuberculous matter 
and leucocytosis together indicates that there is no pus. 

Illustrations under tuberculosis show the leucocytosis in 
acute tuberculosis. It ocurs in either tuberculosis or fibrous 
"consumption." And when the ameboid leucocytes predomi- 
nate it is an indication that the bowels are involved in the 
tuberculous process or at least the mesenteric glands from 
which most of these cells originate. 



286 



DIAGNOSIS BY MEANS OF THE BLOOD. 



METHOD OF ESTIMATING THE DEGKEE OF LEUCO- 

CYTOSIS. 

It is well known that the determination of the number of 
white blood cells is useful both in diagnosing disease and in 
determining the opportune time to use the knife in surgical 
operations. Some diseases have a slight and others a large in- 
crease in the leucocytes. In tuberculosis there is always more 
or less of an increase, while in other troubles — -as in typhoid 
fever — there is either a diminution or they remain normal. A 
great deal also may be discovered from the kind of leucocyte 
present in the field. Theoretically each organ in the body has 
a white cell peculiar to itself, and when an organ needs repair 
it is the cell of this organ that multiplies and does the work. 
The same principle is seen in all nature, even in the labors of 
man. We have, for example, professional men for one kind of 
work and laborers for other kinds of work. If a railroad is to 
be built, or a stream to be spanned, the special laborer is 
called in to do the work, and the number employed is in pro- 
portion to the amount of work to be done. 

Practically, there are very few organs in the body in which 
the corresponding characteristic cell can be recognized in the 
blood or anywhere else, yet it is known that in all repair there 
is an increase in the cells of that part whether it be in a 
chronic or an acute disorder. The white blood cells in the 
body have been referred to quite appropriately as the police 
force. Yet in the body, as in the municipality, some disturb- 
ances are settled without the blue uniform. When the law-re- 
storers are needed, they come quickly or slowly, according to 
the suddenness or severity of the disturbance. So in the body; 
in an acute serious disorder they come quickly and in quanti- 
ties; or if the trouble is chronic, these cells come slowly and 
according to the necessities. Thus in acute appendicitis, or any 
abscess, if rupture occurs, there is suddenly a leucocytosis in 
the blood which indicates an immediate operation. So there is 
an increase in the leucocytes in many diseases. I shall take up 
only those of which I have taken photographs, since other 
works deal more thoroughly with this subject than I care to. 



LEUCOCYTOSIS. 



287 



I shall, however, explain the method I employ for counting 
the leucocytes, and it will be seen from the figures given that 
allowing for the difference in the ratio, the red cells can be 
estimated at the same time and in the same way. 

The figures given here are with the ordinary microscope as 
used for general blood examination; by length of draw tube 
160 millimeters (10 in.) the usual length of tube, with the usual 
eyepiece (2 in.). The figures will be given both for the 1-6 and 
1-12 objective, the ground glass of the camera being 12 inches 
distant. 

With the above conditions an ordinary field of the micro- 
scope covers a plate 3x1 when developed. A red corpuscle on 
this plate measures 1-8 inch in diameter with a 1-6 obj. Hence 
the greatest number that will cover an entire field closely 
packed, edge to edge, is 1-8 x 4 = 32 x (1-8 x 3) = 768. 

Another calculation. Surface of plate — 3 x 4 = 12 sq. in. 
Square surface of corpuscle 1-8 x 1-8 = 1-64; 12 x 1-64 = 768. 

With a 1-12 obj. the corpuscles measure 1-4 inches in diam- 
eter. Calculating this as we have the above we get 192 red 
cells to the field. Or 1-4 of the above (area) 768= 192. 

There are from 300 to 400 red cells to one white in the nor- 
mal blood.* Hence two or three leucocytes to the field or 
photo-micrographic plate is normal according to the above 
figures: 768^-300 = 2 + with a 1-6 obj. If the 1-12 obj. is used 
there will be one leucocyte to every two fields, reckoning 200 
to the field. It will thus be seen without further explanation 
that the red cells are compared at the same time with the 
white. It is much easier, and just as practical, to speak of ten 
white cells to the field or to the normal number of red (350) 
and far easier for either the physician or the laboratory man 
to estimate by this method than it is for him to use the Thoma- 
Zeiss apparatus and the nomenclature adopted for that instru- 
ment. In fact, the everyday physician understands the former 
and he does not the latter. In using the above method, it is 
always best to get the average of five or six fields. This can be 
done in a few seconds with a little practice. 



* See Tuberculosis, foot-note, page 25. 



288 



DIAGNOSIS BY MEANS OF THE BLOOD. 



Dr. Alfred C. Croftan, in the "Journal of the American 
Medical Association," February 25, 1899, calls attention to 
this simple method of counting cells. He claims that there are 
normally one leucocyte on the average to every fifth field of 
his microscope. However this may correspond with the 
author's observation does not matter, for every man must de- 
cide this for his own instrument. In closing this subject, I 
quote one of Dr. Crawford's paragraphs: 

"The counting of the red and white blood corpuscles is a 
tedious and, to all intents and purposes, an inexact procedure. 
Discrepancies, running into the hundred thousands in the red, 
and the hundreds in the white cells, will occur. Information 
sufficiently accurate for diagnosis can be obtained in this di- 
rection from a single glance at the colored blood-slide. The 
same, though not quite so radically, may be said of the de- 
termination of the hemoglobin; the percentile measurement of 
this constituent of the blood is a simple procedure with the aid 
of Gower's or Fleischl's apparatus; but it is not necessary, and 
in my experience again a careful and appreciative study of 
the blood-slide will gh r e information that suffices for diag- 
nostic purposes." 



Fig. 98.— Leucocytes. 




Fig. 100.— 1-7 obj. White blood cell with long thread-like prolongation. 
Figs. 101 and 102 are the same cell in the same position with a higher power. 




Fig. 102.— Remainder of thread-like process of leucocyte. Probably after some enemy. 




LEUCOCYTOSIS. 



REMARKS ON THIS METHOD FOR COUNTING 
BLOOD CELLS. 

It will be said that the above figures are not absolutely cor 
rect for the number of cells is given arranged edge to edge. If 
the cells were arranged in perfect rouleaux (the cells measur- 
ing 1-16 in. for 3 with the 1-6 obj., 2-16 in. for 3 with the 1-12 
obj.) there could then be seen in the field 4,608 and 1,152 re- 
spectively. This never occurs. If it should the blood would be 
perfectly healthy, and there would be no need of a count. If it 
did, there would be 15 whites to the field in the first instance 
and 3 to 4 with the 1-12 obj. and the blood would still be nor- 
mal, in fact, theoretically healthy — an impossibility. Infants" 
blood comes the nearest to this and then the rouleaux are 
short. Quite often there are a few cells in rouleaux and some- 
times half the field; but this is readily taken into considera- 
tion with a little experience in estimating. 

Again, this method can easily be transformed to that used 
by the Thoma-Zeiss apparatus if desired. If in the field of the 
microscope there is one-half the number of red or twice the 
number of white cells normally present, then there are only 
2,500,000 and 16,000 to the cubic millimeter, respectively, by 
this method, and so on according to the proportion. One 
method is easily translated into the other. (See Figs. 103-104.) 

With the hemacytometer it is the custom to consider nor- 
mally 7,000 white cells to the cubic millimeter, and 5,000,000 
red ones. The counts of the former can readily be made to cor- 
respond to the latter method by a slight calculation as above. 
At the present day the latter method is the acceptd one, but 
it is not the most simple. At the same time the method is a 
good one if one is willing to take the time necessary for a dry 
count. 

When I was studying higher mathematics, the professor 
told the class that no one could remember how to work out all 
the formulas, but the fact that we once knew how and did so 
was sufficient. So if one has once known how to count the 

295 



296 



DIAGNOSIS BY MEANS OF THE BLOOD. 



blood-cells with the Thoma-Zeiss apparatus, that is sufficient. 
Such can use the former method and if necessary translate 
their figures into the latter way of counting, for one is just as 
accurate for practical use as the other. If one wants to use 
the dry method and has the time let him do so. 

In discussing this point recently with a physician who be- 
lieved in using the latter method only, he said that he was 
called a few days ago to make a count in a hospital for an 
opinion in regard to a diagnosis. It seems the resident physi- 
cian had made a leucocyte count of 60,000. My friend made 
the count, I should judge, about an hour after the former, and 
he made the number 15,000, he said. The result was that the 
operation intended was not performed. I maintain that so 
long as the surgeon had the most confidence in the latter 
man's count, that his count by the other simple method would 
have answered the same purpose, and might been done in one- 
fiftieth part of the time. In fact, the surgeon can learn to make 
the calculation himself; for it is simply a matter of judgment. 
In view of the fact that two unacquainted and independent 
observers can scarcely come within 20% of each other* by the 
Thoma-Zeiss apparatus, it seems that the method first men- 
tioned is the one to be preferred. 

If the surgeon in a case to be operated upon is not ac- 
customed to blood examination, he should give the symptoms 
to one who is and in whom he has confidence, and let him by 
his blood test determine whether or not there shall be an 
operation. 

The method of counting in common vogue and the figures 
given by different operators reminds me of an adage in regard 
to the three kinds of statements, each one being a little more 
inaccurate than the previous, viz: — "Lies, damned lies and 
statistics." Keally, the value of any blood-count is only ap- 
proximate. The number of passengers carried on the railroads 
in India has increased from 2,000,000 in 1857 to 160,000,000 in 
1896.* Here is a vast difference, and figures are of service to 
convey some idea. This illustrates the value of blood-counts; 



* See Bibliography. 



LEUCOCYTOSIS. 



297 



for, unless there is an enormous difference between the count 
at one time and that at another, the figures are of no value. 
Therefore, one method of estimating is just as accurate as the 
other. The more simple is therefore preferable, and that is by 
estimating without the hernocytometer. 

I have given the maximum and the minimum blood-counts 
in a definite field of the microscope. Actually and practically 
it is difficult to pick out all the leucocytes or red cells in a field 
because of their piling on top of each other and their cleaving 
together. Therefore, according to my experience in normal 
blood with a 1-6 obj. and a 1-12 obj. there are respectively 2 to 
3 and 1 to 2 leucocytes to the field with the ordinary No. 1 eye- 
piece. Whether the red cells are diminished in proportion to 
the serum or not can be told with a little experience by the pro- 
portion of red cells in the field and the way they float about. 

The following opinion is based on up-to-date hematology. 
It is placed here because the discussion hinges on the dry 
method of blood examination. Such examinations rely for 
their results mostly on the number of cells in a given field by 
the Thoma-Zeiss method of counting. 

The problem of the examination of the blood for clinical 
purposes has been approached from two standpoints. One of 
these is that of the hematologist, the other that of the clini- 
cian; and curiously enough — or perhaps the matter is not so 
very curious, because on almost every question of methods 
this same result has ensued — there has been a considerable 
lack of agreement between the two parties, the clinician argu- 
ing that the results are too indefinite to enable him to diag- 
nose his cases with accuracy; the hematologist, that the clini- 
cian — insufficiently familiar with the technique employed — is 
incapable of interpreting the results accurately. 

As a matter of fact, we believe that in this dispute the fault 
lies largely with the hematologist, for if his results are not 
sufficiently precise and conclusive to enable the clinician to 
use them in his actual practical work, they are, from the clini- 
cal standpoint, of minimal value. Furthermore, if his reports 
are returned to the clinician so late that the latter is com- 



298 



DIAGNOSIS BY MEANS OF THE BLOOD. 



pelled to act upon the ordinary symptoms and signs of disease 
before receiving them, their value can be regarded as nil. On 
the other hand, the clinician, as the man upon whom the re- 
sponsibility for action is placed, has the right to demand pre- 
cise, definite reports, returned in the briefest possible space 
of time, and when such reports are not forthcoming, his criti- 
cisms and complaints are fully justified. 

Dr. John B. Deaver, of this city, is undoubtedly a man 
whose clinical experience in surgery has qualified him to speak 
upon the question of surgical diagnosis; and as a man em- 
ploying, or having employed for him, all methods of the ward 
or laboratory to confirm his diagnosis, he is qualified to ex- 
press an opinion upon such methods that is worthy of the 
most respectful consideration. Eecently he has called forth 
the protests of certain hematologists by his criticism of the 
value of blood examinations in surgical conditions, and in his 
most recent article, published in this number, as a sort of reply 
to these protests, he has reviewed the entire subject of blood 
examinations. The one point concerning which there has been 
the greatest amount of dispute is the value of leucocytosis as 
a symptom of disease. Now leucocytosis, it must be admitted, 
is a sign of certain general states, and practically never a dis- 
tinguishing sign of a particular local lesion; and when Dr. 
Deaver argues that it is insufficient to establish a differential 
diagnosis between tubal suppuration and appendicitis, 
he assumes a position that is absolutely unassailable. We 
think that on the whole his standpoint is a good one; that 
leucocytosis is not to be regarded as a final arbiter in ques- 
tions of operative interference, but that it is simply a contribu- 
tory symptom of considerable value, not yet as thoroughly 
understood as it might be, but never to be entirely neglected 
in any case. — Editorial, the Philadelphia "Medical Journal," 
November 23, 1901. 




Fig. 104.— Increased white cells, about 30,000 to the cu. m.m. 
299 



FURUNCULOSIS 

(BOILS.) 



The young man from whom this drop of blood was taken 
had a boil on the back of his neck. I show the photograph to 
illustrate the increase in the number of white cells in furuncu- 
losis, and also to illustrate the method of keeping a permanent 
record which may be referred to at any time, with the actual 
number of cells in the field. Fig. 105. The second photograph 
is taken after the boil had discharged and healed. Fig. 106. In 
it there will be noticed the return to the normal condition — 
one or two white cells to the field. 



303 



NEUROSIS. 

IT LS FOUND THAT THESE CELLS ARE POUND MOSTLY 
[N PERIPHERAL NERYE AFFECTIONS. 



NEUROTIC CASES. 



MICROCYTES. 

My observations have shown that microcytes are abundant 
in many neurotic disorders and in some of the diseases classed 
under the head of diseases of the nervous system. They are 
more noticeable, however, in functional nervous disorders, in 
which the patient is fidgety and when there is loss of nerve 
force due to overstraining of the mind in business cares, also 
to lack of harmony in the sympathetic nervous system. Ac- 
cording to Vierordt,* Osier and others, these microcytes are 
abundant in pernicous anemia. My theory as to the cause of 
this is that the nerve fluid does not have time to complete its 
normal circuit and thus the blood corpuscles do not have time 
to attain their true size and the result is these "dwarf cor- 
puscles" or microcytes. Therefore I class this appearance un- 
der the head of neurotics. 

CASE I. 

A banker was visiting me one evening. Being of a scientific 
turn of mind, he asked me to photograph his blood simply to 
show him the work and how it was done. I did so, and as the 
picture began to develop before us in the dark room, these 
dwarf cells became faintly visible; I thought to myself: "This 
man is nervous, fidgety, always on the rush." So, as the pic- 
ture finally came out, I said to him : "If I did not know you I 
would think from this picture that you were a very nervous 
man." 

He replied immediately, "Why, I am. I can't keep still ten 
minutes. I am always on the go, and I wish I could get over it." 

Although I had noticed his condition before, this seemed to 
confirm it; and from that time on I noticed the appearance of 
these microcytes more and more in neurotic people. 

The photograph of this man's blood taken with a 1-12 obj. 
and low eyepiece is shown (Fig. 107). 



* See Bibliography. 



309 



310 



DIAGNOSIS BY MEANS OF THE BLOOD. 



CASE II. 

The isolated small blood-cells in the second picture (Fig. 
108), remind one of the microscopical appearance of milk. 
John Hunter, in his book on the blood, written in 1796, reports 
two cases of women from whom he took blood (venesection), 
and he said it resembled milk even under the microscope. It 
"had no color when drawn," and hence looked milky. Dr. 
George Dock, of Ann Arbor, if I remember correctly, recently 
read a paper relating a case in which he said the blood was 
white, due, however, to the large number of lucocytes. 

I am not aware that these cells referred to above have been 
investigated by any other observer in this connection; and I 
think that their discovery is original with me. 

CASE III. 

The blood shown in this photograph (Fig. 109) is that of a 
man weighing 200 pounds and not over 5 feet 10 inches in 
height. He has the appearance of perfect health; but he says 
that it is difficult for him to go out of the house because of fear 
that something should happen. The large number of micro- 
cytes (small red cells) here, the crenated edges and the watery 
condition of his blood indicate that he is in a neurotic condi- 
tion. One would think from this man's looks that he is a good 
subject for apoplexy of the embolic variety. But it is not so. 
He is more likely to have paresis. There is no rheumatism 
here, yet there is a condition which does not show in the pic- 
ture, and which might be the cause of this whole disorder. 




Fig. 108.— Milk globules (apparently). 
311 



POIKILOCYTES. 



DEFORMED OR WEAK RED CELLS. 



POIKILOCYTES. 



ILLUSTRATIVE CASES. 
CASE I. 

Poikilocytes are deformed red corpuscles. Those shown here 
are taken with a 1-6 D Zeiss objective. (Fig. 111.) When these 
are found in the blood of a person, it is simply an indication of 
weakness, a run-down condition due to some cause, known or 
unknown. 

It was first thought that these cells were indicative of can- 
cer and later of pernicious anemia, but now they are known to 
be diagnostic of neither, for they are found in many conditions 
and simply mean, as does a slight increase in the white cells, 
that we must look further for the trouble, inquire into the 
cause — in other words, study collateral symptoms. 

In another case here illustrated (Fig. 112), the man was 
nervous, fidgety and weak, and had a great deal of trouble 
with his eyes. All this was due to lack of nerve power, caused 
by overwork. He sold out his business and retired; and I un- 
derstand is to-day feeling better than ever before in his life. 

CASE II. 

I reproduce this photograph (see Fig. 110), not for its 
beauty and technical art, but because it contains — besides 
the poikilocytes of Ehrlich — great quantities of the invisible 
corpuscles of Norris. They can best be seen with a hand mag- 
nifier and are most noticeable in the upper corner of the photo- 
graph. They were not discovered until I examined the nega- 
tive a few days ago, yet the photograph was taken three years 
ago. According to Osier, they are the red cells before they 
have received their coloring matter. (See American Text Book 
of Theory and Practice of Medicine, in which he merely al- 
ludes to the fact.) In 1885 Norris, an Englishman, wrote a 
book on the subject which contains good photo-micrographs. 

317 



Fig. 110.— Invisible corpuscles of Norris seen in the serum between the cells, in upper 

left-hand corner. 




VITALITY. 



Flabby, irregular cells indicate weakness in proportion to 
their number. Many full, round cells indicate proportional 
strength and vitality. 



3 23 



.1 



VITALITY. 



The nervous strength or vitality of a person is, so far as my 
observation goes, always indicated by the roundness of the 
red cells. If the cells are flat or crenated, there is a low state 
of vitality. The former condition is present in long-continued 
fevers and in low chronic disorders. When a person is about 
to die from such disorders, the anemic flabby crenated red disc 
is often very marked. In a strong healthy individual the 
roundness and elasticity of the red discs are characteristic. 
This latter is often disguised by rheumatism, in which the 
cells are sticky, but even here, with experience, the difference 
can be seen. 

When in Paris in 1892 I showed a French physician a photo- 
graph of blood from a living man in which the cells were 
mostly crenated; he remarked immediately that it could not 
be correct, for if blood like that came from a man he would be 
dead. So the fact comes up again that something depends on 
the way the blood is drawn and the time that elapses in get- 
ting it on the slide. If such blood as was shown the doctor in 
question was crenated to that extent in the system, I agree 
that the man would be on the point of death. But the picture 
was taken about one-half hour after it was drawn. 



CASE I. 

The specimen of blood pictured here is from a prominent 
Senator. Fig. 113. The crenation of the red cells, together 
with the increased number of leucocytes, shows simply one 
thing — the man is weak, in fact he is sick. No well man's 
blood will, when freshly drawn, give that appearance. 

In this case, examination made seven months before death 
showed clearly the signs of impoverished blood. 

325 




Fig. 113. — Photograph of biood of a Senator. In this case the examination, made 
seven months before death, showed clearly the signs of impoverished blood 
and low vitality. 



327 



< 



FOREIGN MATTER. 



These pictures are shown to put the reader on his guard; for 
extraneous matter which inadvertently creeps into view under 
the microscope must be constantly kept in mind. 



331 



FOREIGN MATTER. 



The more one knows about the microscopic appearance of 
dirt and plant life, the less he will have to use asepsis in the 
microscopic examination of blood, barring the danger of in- 
fecting the patient, and the more simple the examination be- 
comes. Many errors are made in analysis of objects seen 
through the microscope. The objects thus seen and supposed 
to be in the blood would fill a small book full of interesting 
pictures. (Dust floating in the air, epithelium and dirt on the 
surface of the skin, such as tobacco dust and starch granules 
from various sources.) Imperfections in the glass slides are 
sometimes a bothersome source of error. Dust on the eye- 
piece is very common; but this is easily distinguished by re- 
volving the lens in the tube with the fingers. 

In 1890, when making photo-micrographs of the blood of 
patients on North Brother Island during the typhus fever 
epidemic, the fine dust was so abundant that it was impossible 
to get clear photographs. There seemed to be a storm of dust 
all the time I was there. These particles are often mistaken for 
fine germs Many glass slides obtained from reliable manufac- 
turers contain defects such as air bubbles, specks of ap- 
parently unmixed metals, together with long streaks, due to 
some unknown cause. The most perfect glass for a slide that 
I ever obtained was from a mirror taken from one of the 
United States Government sextants. Photographs of a few 
only of these particles of foreign matter and glass defects are 
shown here. 

The following are a few foreign bodies often found on the 
microscopic slide other than those existing in the blood : 
Gravel. 
Cotton fibres. 
Silk. 

Feathers. 
Epithelia. 

333 



334 



DIAGNOSIS BY MEANS OF THE BLOOD. 



Granules of starch. 
Granules of wheat. 
Beard of wheat. 
Fruit skins. 

Eggs and larva? of insects. 
Fibres from carpets. 
Hairs from beard. 
Oils. 

Spores of cryptogamic plants. 
Cooked food. 
Uncooked food. 



A PECULIAR CASE. 



From hearing others talk many people get the idea that 
this method of blood examination is one by which anything 
relating to the patient can be told. Instead of this it is merely 
an aid to the diagnosis of disease. Some years ago a bilious- 
looking man came to my office to have his blood examined. He 
said be had heard of me, that he came a good ways, had not 
much money, and therefore would like to explain what he 
wanted before he paid me, in order to see if I could satisfy 
him. He then said : "I am a painter by trade. My mother was 
a German and my father was a Frenchman, I am told. I 
seem to have two classes of friends — one among the colored 
race, the other among the white. Neither will own me. They 
both ridicule me and say I do not belong to them. Now, what 
I want you to tell me is whether I am a white man or a nigger. 
I do not know." 

This was certainly a painful position, for the man was in 
earnest, and I was sorry to be obliged to inform him that I was 
unable to serve him. 



341 



MISCELLANEOUS. 



These are only a few of the odds and ends that I have taken 
from my photographic workshop. 



345 



MISCELLANEOUS. 



Bacilli (germs) in blood of person apparently healthy. 
(1-12 obj.) Fig. 117. 

Swollen white blood cell. (1-12 obj.) Pig 118. 

A plant in the blood of a man with advanced tuberculosis 
of the lungs — the ribbon shaped appearance. Fig. 119. 

Pus and blood-cells, together with a large tailed cell filled 
with granules, in the lower middle of the picture. From a sup- 
posed hemorrhagic carcinoma of the cervix. Fig. 120. 

Eed blood-cell and fibrin highly magnified. One would think 
this was taken with a high power objective, from its size, but 
it was not. It was taken at night by the use of an artificial 
light. I had a box made 15 feet long, with proper arrange- 
ments at either end. I worked down cellar at one end, and a 
friend observed upstairs, at the ground glass end. On account 
of the crudeness of the apparatus, it was only practical to 
work in the middle of some stormy night. It was then dark. 
We could see these small baseballs floating across the thin 
ground glass plate. This picture was taken when the cell was 
in motion. Fig. 122. I also took photographs, which I still 
have, of the red cell, which measures 3 1-4 inches across. But 
these high magnifications are of no practical value; it is there- 
fore useless to spend one's time on such work. 

Cast from bronchial tube (sputum). Fig. 123. 

Rotifer in Croton water. Taken as it was swimming across 
the field. Resembles a fish. Exposure instantaneous. Fig. 124. 

A little animal often found on the skin when not cleaned. It 
is that which gets mixed with the blood as seen here. I have 
seen it taken for the echinococcus when seen in the urine. 
Fig. 125. 

Pleurosigma angulatum 1-25 Tolles obj. Fig. 126. 

Micro-motoscope picture of blood moving under the micro- 
scope, etc. Figs. 127-128-129. For description of instrument 
see page 367. 

347 




Fig. 118.— Swollen white cell filled with fat globules, etc. 
349 



Fig. 119.— Plant in the blood— airbubbles. Patient, a sailor, was in Bellevue Hospital. 





Fig. 123. — X 5,000. Large red corpuscle, fibrin, crypta syphilitica. (Large white speck 

on the fibrin.) 



353 



Fig. 123. — Cast from the bronchial tube. 




Fig. 124. — 1-6 obj. Rotifer from Croton water. Photo taken with ordinary camera 
as the small animal swam across the field. 



355 



Fig. 125.— Spharrothae tyrae (Moore). A plant probably from the skin, sometimes 
found in the blood. 





Fig. 127.— 1-12 obj. Germs on fermenting urine jumping about. 




859 




Pig. 130.— Tubercle bacillus. Photograph taken from a case of 
Dr G. Lenox Curtis, in 1898. 

361 



Fig. 133.— Upper right-hand corner is a string of cotton; looks like a 
thick piece of fibrin. 
Rheumatic arrangement of red cells with the fibrin in the serum. 




THE MICRO-MOTOSCOPE. 



THE MICRO-MOTOSCOPE. 



The micro-motoscope, as has been said, was gotten up with 
the idea of recording the changes that take place under the 
microscope in blood and reproduce them on the screen for the 
benefit of the student or investigator. It was found to work so 
successfully that it has been adapted to other cell changes and 
other microscopic life. It was recently demonstrated to a rep- 
resentative of the American Biograph Company, who, by this 
time, have probably improved on the original, and I under- 
stand, if the public are sufficiently interested, they intend to 
go into this line extensively. The author described the pictures 
taken with his apparatus in the "Scientific American" some 
years ago. 

Some have desired the author to describe the apparatus, 
with drawings in detail; but such is unnecessary, for in the 
rough it is very simple; all that is necessary to do is to place 
a rapid picture-taking machine over the top of a microscope 
in a dark-room. Sunlight will do the work, but an electric en- 
closed arc lamp is the best; it takes a picture quicker than 
sunlight and it is the most easily manipulated. 

It is better for this purpose to place the microscope in a 
horizontal position, putting the light in a dark box. If one de- 
sires to focus carefully and to watch the picture while it is 
being taken, a binocular microscope should be used, placing 
the camera over one tube and looking into the other. 

Motion picture-taking machines are described under so 
many terms by different men that it is difficult to keep track 
of the names. The "Photo grams" of 1897 calls the process 
kinetography. This periodical, in speaking of the micro-moto- 
scope, says that "during the year two distinct steps have been 
made in kinetography." This editor then goes on to say that 
one was by Dr. Macintyre, of Glasgow, the other by Dr. 
R. L. Watkins, of New York. Dr. Macintyre com- 
bined kinetography and radiography and was able to 
reproduce the movement of the bones in the living 

367 



368 



DIAGNOSIS BY MEANS OP THE BLOOD. 



in the living limb. Dr. Watkins, on the other hand, combined 
kinetography and photomicrography, so as to be able to record 
and reproduce the movements of objects so small as cor- 
puscles, rotifers, microbes. This power of studying the motion 
of the corpuscles is expected to prove of infinite value in the 
diagnosis of certain diseases. From this it will be seen that 
kinetography, which commenced as a scientific industry, has 
made distinct steps in scientific progress, in addition to capti- 
vating the public taste. 

In the illustrations 12 pictures of each object are shown. 
In order to get the live motion on the screen from 12-16 of 
these pictures should be taken every second. In the book 
shown here there were 16 per second — i. e., 960 per minute. 

See Figs. 127-128-129 on page 359. 



ANTI-TOXINE. 



ANTI-TOXIXE. 



This shows the effect of one dose of anti-toxine on the blood. 
The afflicted child had diphtheria of a severe type. The anti- 
toxine was injected as soon as the disease was recognized. 

In a few hours paralysis of the vocal chords set in, but the 
child made a good recovery. 



371 



Fig. 135. — 1.-12 obj. Before using anti-toxine. 




LAST REMARKS. 



LAST REMARKS. 



The blood is now examined microscopically in every well 
regulated hospital, both in this country and in Europe. No 
physician can afford to neglect to examine the blood of his 
patient, for it will throw light on all diseases. 

For examination of fresh blood, I would like to repeat the 
directions, because as much depends on the way the blood is 
drawn and placed on the slide as on the examination itself. 

First, clean the wrist with either hot water or some anti- 
septic solution. 

Second, make the prick there with a clean, sharp lance. 

I prefer the one I have illustrated, because of the ease with 
which the operator can regulate the depth of the insertion and 
because it can be done so quickly that it will not be felt. 

Third, squeeze the blood out of the wound. This is in order 
to get the fibrin, which floats near the wall of the blood 
vessels. 

Fourth, place the cover glass in contact with the drop. It 
will adhere. Place this on the slide and examine. 

There are some things that can most always be seen by any 
one. 

In rheumatism you will always find the fibrin, and in tuber- 
culosis the tuberculous matter, two of the diseases most often 
found in the practice of the physician. It is not the rare dis- 
eases in which the busy practitioner needs to be instructed so 
much as the common ones. 

Examine for yourself, and never, except in special cases, ex- 
amine dried blood; use it fresh. 



377 



BIBLIOGEAPHY. 

The references here are given in the order in which they occur on the page 
specified. 

Preferences on page 17: 

Dr. Geo. M. Gould, Journal of American Medical Association for 
July 21, 1900. Article read at Atlantic City, June 5, 1900. 

Page 75 : 

Quain's Dictionary of Medicine, page 1662. 
Magendie on the Blood, page 13, edition 1839. 
Quain's Dictionary of Medicine, page 1663. 

Page 76 : 

Watson's Practice of Physic, page 135. 
Quain's Dictionary, page 1663. 

Page 77: 

Loomis and Thompson, American System of Theory and Practice of 
Medicine, page 731, first paragraph last italics. 
Quain's Dictionary, page 1667. 

American Text Book of Theory and Practice of Medicine, page 569. 
Page 78 : 

American Text Book of Theory and Practice of Medicine, page 570, 
edition 1896. 

Page 79 : 

Dr. H. H. Cordier, Journal of American Medical Association, Nov. 3, 
1900, also reports such cases. 

Dr. Joseph Matteson, Journal of American Medical Association, 
May 12, 1900. 

Page 80 : 

American Text Book of Theory and Practice of Medicine, Vol. II, 
page 569. 

Page 85 : 

Quain's Dictionary, page 1669. 

379 



380 



BIBLIOGRAPHY. 



Page 86 : 

Albutt's System of Medicine, page 15. 
Page 90: 

Troussert — Microbes, Ferments and Moulds. 
Page 91 : 

See Quain's Dictionary, also 



Watson's Practice of Physic, last paragraph. 
Page 93 : 

Dr. Wm. F. Northrup before New York Pathological Society, 



•< Feb. 26, 1890. 

(_ The Eelations of Alimentation to Disease, by Salisbury. 
Hawes, "My Musical Memories." 

Page 146 : 

Grarrod's Gout and Rheumatism. 

Dr. James White Moore, Journal of Hematology, October, 1899. 
Page 183 : 

Medical Week, Aug. 10, 1896, page 402, paragraph 5. 
Page 184: 

Medical Week, page 401, Aug. 10, 1896 (last column and last para- 
graph). 

Page 186 : 

F. Magendie on the Blood, page 26, 1839. 
Page 187 : 

Vita Medica, by Sir Benj. Richardson. 
Page 229 (M. K.): 

Journal of American Medical Association, Oct. 5, 1901, editorial. 




BIBLIOGRAPHY. 



381 



Page 231 : 

Paper on Gunshot Wound of the Intestines before the New York 
State Medical Association, Oct. 24, 1901. 

Page 23!) : 

Von Ziemmsen, Practice of Medicine, Vol. Ill, page 40. 
Capt. Dabey's Translation of an Old Chinese Medical Book. 

Page 240 : 

Dr. L. Duncan Bulkley, Syphilis as a Non- Venereal Disease, Journal 
of the American Medical Association, April 6, 1901. 

Page 245 : 

American Journal of Medical Sciences, January, 1868, J. H. Salis- 
bury. 

Also Journal of Hematology, April, 1901. 
Page 246 : 

Bacteria, by Geo. M. Sternberg, 1885. 
Page 249 : 

The Clinical Morphologies, E. Cutter, 1892. 
Page 277 : 

Journal of Morphology, by Howard, page 93, 1890. 
American Text-Book of the Theory and Practice of Medicine, page 
184. 

Page 278 : 

American Text-Book, Theory and Practice of Medicine. 
Page 296: 

American Text Book of Theory and Practice of Medicine. 
Expansion, by Josiah Strong. 

Page 307 : 

Vierordt's Medical Diagnosis, page 276. 



INDEX. 



A 

PAGE 

American Medical Association 17 

Addison, W 76 

Aubon, Dr 244 

African Blood 262 

Anti-Toxine 369 

American Investigators 13 

Aphasia, agraphic 49 

Animals inoculated with Tubercles. . . 89 

Anti- Vivisection Society 91 

Autopsies, unsought 91 

Arterio- Venous, System 145 

Acid, Oxalic 147 

Acid, Acetic 147 

Asthma, due to Cystin 149 

Ameboid Leucocytes 285 

Appendicitis, leucocytosis in 286 

Actual value of blood count (Illus.) 287-295 

Apoplexy, good case for 309 

Air bubbles in glass slides 332 

Animal on the skin 348 

American Biograph Co 367 

Auras of Disease 17 

B 

Blood, How to get it 27 

Bayle, Dr 75 

Bizzozero 82 

Bradley, Dr. E 138 

Banker's Blood 308 

Blaine, Jas. G 232 

Bacilli in the Blood 342 

Bibliography 379 

Blood, a vital organ 13 

Blood reveals disease in incipiency. ... 18 
Blood reveals disease in advanced 

condition 18 

Blood, science of 20 

Blood Letting 20 

Blood, not studied at all 20 

Bleeders 21 



PAGE 



Blood, to study must note 1st, 2d, etc. . 27 

Blood poisoning suspected 49 

Brown, Dr. G. C 49 

Blood, thick and thin 50 

Blood, Dyscrasia Tuberculosis 76 

Blood, Nidus of, in Tuberculosis 80 

Bacteriology (Sternberg) 89 

Board of Health 100 

Bellevue Hospital 101 

Blood poisoning case of Dr. Bradley. . 138 

Blood in Rheumatism 141 

Blood count, value of (Illustrated). 287-295 

Bacilli in Blood 344 

Blood cell, swollen white 344 

Binocular microscope for micro-moto- 

scope pictures 363 

C 

Cohnheim 91 

Curtis, Dr. G. Lenox 99, 103 

Cystin in the Blood 147 

Cystinemia 148 

Crystals in the Blood (Illustrated). . . . 165 

Cholesterine 169 

Cystin Crystals 175 

163 

Cow's Blood 189 

Cardiac Diseases 203 

Columbus 239 

Cells, counting the fad 21 

" counting inaccurate 22 

Consumption, Fibroid 85 

Fibroid, slowness to see. 85 

' ' not mistaken in 101 

" hemorrhagic Fibroid. . . 103 

Contagion, caused by a germ 92 

Cure due to rest 101 

Conditions, to opposite 102 

Cystin, hexagonal 147 

" calculous 147 



383 



384 



INDEX. 



PAGE 



Cystin, tissues 148 

" in Kidney 148 

" in nervous system 148 

" produces thick Blood 148 

" enlarges Joints 148 

" produces Gout 148 

" in urine 148 

in the epithelium 149 

" in the stomach and liver 149 

" seen by Virchow 149 

" Iridescent 149 

'" cause of catarrh 149 

' ' the cause of vaginal catarrh . . . 149 

" cause of spermatorrhea 149 

" composed of sulphur, etc 149 

Cystinemia, cause of Hysteria 149 

basis of treatment 150 

Clots, traveling 185 

" dissolved by salt 187 

Cells, rope-like mass 186 

Clots, effect of acids on 187 

Comet in the heavens 188 

Cow, dizzy 189 

Crypta Syphilitica 243 

Cell, double contoured in malaria 269 

Cells multiply in proportion to work. . 286 

" large-tailed, double contoured. . . 349 

Cromatin, lumps of 278 

Calculation of cells in the Blood 279 

Crenated red cells 324 

Blood 326 

Crude apparatus in photographing... 342 

Cast from bronchial tube 347 

Croton water rotifer 347 

D 

Dedication 9 

Dry Blood 43 

Delafield, Dr 75 

Dana, Dr. Chas. L. 103 

Doty, Dr. Q. E 217 

Darwin 249 

Diagnosed easily by the student 17 

Dry Blood, examine no 20 

Disease called by name 22 

' ' never exists alone 22 

" most conspicuous 22 

causes pain 22 



PACiE 



Disease produces the deformity 22 

Dieu Hotel 75 

Dynamo 94 

Diseases, two opposite 102 

Diagnosis, negative 104 

Dynamo machine 230 

Degeneration cells 281 

Deformed or weak cells 315 

Dirt on slide 333 

Dust on eye- piece 333 

E 

Embolism 179 

Embolic Fibrin 189 

Erlich, the original pioneer 21 

Epithelioma 188 

Embolus, composition of 185 

" pathology of 183 

" discussed at French Congress 183 

" injection of substances in .. . 186 
" composition of by Jones and 

Zahn 184 

" Leucocytes and Fibrin iu. . . 185 

" Fibrous in heart 203 

Endocarditis with Rheumatism 205 

Epithelium 333 

Electric Light better than sunlight. . . 367 

F 

Funke, Otto 20 

Friedlander 77 

Fibrous Consumption 85 

Further Discussion (Tuberculosis). ... 89 

Furunculosis 301 

Foreign Matter 329 

Fresh Blood, pathology lies in this ... 18 

" " specimens 20 

Fibrin in 21 

Fibrin constituent of Blood 21 

" due to whipping the Blood. ... 21 
Fresh Blood examination, method of 

procedure 27 

Fibroid, Tuberculosis 80 

" consumption, slowness to see. 85 

Fibrin, Rheumatism 145 

" thick Pathological 145 

" crystals 146 

" causes pain 145 



INDEX. 



PAGE 



Fibrin, skeins, Dr. Loomis 151 

" with net work intact 189 

" cylindrical uet work 189 

manufactured by 278 

Fresh Blood only 262 

Q 

Gould, Dr 18 

Garfield 229 

Golasz, Dr 244 

General Practitioner 13 

Gout 17 

Gynecologists, unskilled 19 

Germs , 21 

Granular Mattel-, composition of 78 

Germ cannot exist alone 81 

Granules in Blood have puzzled Phy- 
sicians 78 

Granules in Blood are Blood Plagues, 

etc 78 

Granules in Blood are Tubercular 

Matter 78 

Germs in Blood 337 

Gangrene in McKinley 231 

Gonococcus of Neisser 246 

Glass, defects in 332 

H 

Hunter, John 20 

315 

How to get the Blood 27 

Healthy Blood 59 

Hippocrates. 78 

Hayem 82 

Hoag, Dr. Ward B . 102 

Hanks, Dr. H. D 138 

Hippuric Acid 171 

Hallier, Dr 246 

Hall, Dr. G. R 261 

Haematologists 18 

Haemoglobin, a secondary matter 21 

Healthy Blood, photographs of 57 

Hobby, ride no 87 

Hospital, Sloane Maternity 121 

Hemoptysis case, not tubercular 129 

I 

Introduction 17 

Inherited Tuberculosis 104 



385 

PAGE 

India \ 204 

Investigators, American 13 

Illustrative cases 49 

Iron clad rule of Bacteriologists 89 

Italy, Tuberculosis considered conta- 
gious 92 

Infants, Tuberculous, due to sweets. . . 94 

Invisible corpuscles of Norris 317 

Imperfections in glass slide 333 

K 

Koch, 4 rules of 77-90 

Koch 77 

Katzenbach, Dr. Wm. H 151 

Klebs-Loefler 239 

L 

Lances: 29 

Loomis, Dr. A. L 105 

151 

Leprosy 241 

Laveran's Letter 260 

Leucocytosis 283 

Last Remarks 377 

Laboratory worker 13 

Lenses employed 15 

Laboratory, none required 17 

Laveran, plasmodium of 90 

268-275 

Lupus 129 

Leucocytes, decrease of in typhoid . . . 286 
" increase of in Tubercu- 
losis..;...-....'... 286 

" inaccuracy of, illustrated 

by a case 295 

M 

Method of Procedure 25 

Moving Blood Cells 37 

Method of Examining a Photograph 

for Disease 49 

Magendie 75-186 

Malassez 79 

Murphy, Dr 79 

Martinot, Sadie 152 

Meningitis 221 

McKinley 's Case 225 

Malaria 255 

Method of Estimating Leucocytosis. . . 289 



386 



INDEX. 



PAGE 

Miscellaneous 343 

Micro-Motoscope Pictures 359 

Micro-Motoscope, description of 365 

Microscope, the cause of mistakes 19 

Microscopists, unskilled 19 

Music 19 

Metabolized Food 94 

McKiuley, Dry Method of Examina- 
tion used 239 

Mosquito, in Malaria 257 

Malaria, hyaline body in 259 

Method of counting the Leucocytes. . . 286 

Milky Blood 310 

Metals in glass slide 333 

Micro-Motoscope Pictures 345 

N 

Neurosis 307 

Norris, corpuscles of 316 

Naked eye, studied with 20 

Nodules, old 89 

Nerve power 94 

Night sweats 89 

Nodules in uteris 138 

Nervous energy, McKiuley 231 

Neurotic people, microcy tes in 309 

North Brother Island Examinations. . . 333 

O 

Osier 278 

O'Rell, Max 152 

Operas 19 

P 

Publisher's Notice 11 

Preface ! 13 

Pathogenesis 18 

Paganini 20 

Primitive Tubercle 71 

Pulmonary Tuberculosis 91 

Paralysis 188 

Preamble ' 239 

Pasteur 241 

Poikilocytes 315 

Plant in the Blood 347 

Pleurosigma Augulatum 348 

Photographic objective 15 

" Critic 15 



PAGE 

Photographic Lens 15 

Picture Book 17 

Photographs taken from advanced 

cases. 17 

Pre-symptom 17 

Prognosis by hematologists 19 

Parasite, Filamentous 20 

Physicians, German 20 

Pathological Fibrin 21 

Pioneers of this work 23 

Peritonitis, Tubercular 79 

" " Recovery of Pa- 
tients of 79 

Phthisis 91 

Paralysis due to Fibrin 183 

" premonitory 183 

'"' skeins of Fibrin in 188 

" negative Diagnosis of 188 

Pugilist 230 

Plasmodium 243-262 

Pyarrhcea, Alveolaris 285 

Peripheral nerve affections 314 

Paresis 316 

Plant life on the Slide 333 

Plant in the Blood 347 

R 

Rheumatism 141 

Ruysch, Dr 186 

Remarks on Syphilis 247 

Remarks on the method of counting 

cells 294 

Rheumatism, all tubercular people have 22 
" Affects the entire Blood . 22 

Blood in 141 

Fibrin 146 

" Fibrin, Filaments in 145 

" Crystals in 146 

" Phosphatic 146 

Uric Acid 146 

" Cystin 146 

No germ in 151 

" Advance scout of 151 

Rules are all artificial 90 

Rouleaux, short, in infants' blood. . . . 104 

Ranvier's Granules 184-185 

Red blood-cell, high power 347 

Rotifier in croton water 345 



INDEX 



387 



5 

PAGE 

Spirochota? of Obermeier 20 

Sanderson 76 

Septicemia 133 

Salisbury (The Yeast of) 82 

Sloane Maternity Hospital 137 

Stimson, Dr. D. M 188 

Syphilis 235 

" The Germ of 243 

Story 340 

Soil in fresh Blood 18 

Sims 20 

Socrates 49 

Scrofular Matter 76 

Sternberg's Bacteriology 89 

Soil of Tuberculosis 90 

Sunburn of man's face 100 

Sclerosis of arteries 102 

Septicemia in physician's wife 137 

" in pre-tuberculous women. 137 

Spider's web, fibrin 145 

Solution in the Blood, to modify. . . . 186 
Syphilis transferred by inheritance. . . 

" Germ color of copper 243 

" no Venereal Disease 240 

spore resembles Bees 243 

" Germ lively 243 

" spore, Discovery of 245 

" traced in family 245 

•' " used by many physi- 
cians 246 

" " seen by Vitoscope. . . . 247 

opinions of others in 250 

Starch granules on slide 337 

Sympathetic nerve and microcytes. . . . 309 
Scientific American 365 

T 

Technicalities, no 17 

Therapeutics 18 

Thomases 20 

Tuberculous people all have Rheuma- 
tism 22 

Tuberculosis, Fibrous 22 

Granular matter in 23 

Tuberculous matter 23 

Tuberculosis, Forerunner of 23 

Demonstration of in 

Blood 73 



PAGE 

Tuberculosis, Fibrin 83 

" synopsis of 73 

" further discussion 89 

Tubercle, primative 75 

" Fibrous 75 

" cellular 75 

" deposited from Blood 76 

" composed of, etc 76 

" Blood origin of 76 

a Fad 77 

" more Frequent 77 

" Bacillus, Discovery of by 

Koch 77 

Tuberculosis 71 

Tubercular Matter 75 

Tuberculous Fibrin 83 

Tuberculosis, contagiousness of 91 

Test Case 104 

Tubercle Bacillus in the Blood (Illus.j 131 

Tucker, Dr. E. A 104-137 

Triple Phosphates (Illustrated) 169 

Testimony 250 

Tubercle Bacillus (Illustrated) 353 

Time of exposure of pictures 15 

Tubercle Bacillus, is it cause of 

Tuberculosis? 77 

Tubercle Bacillus, is it first present?. . 77 
carried by Blood.. 77 

Tuberculosis, definition of 78 

Tubercles, what are they? 77 

composition of, Delafield. 78 

" origin of 78 

" review of 78 

Tuberculous Peritonitis 79 

Tubercle Bacilli growth in cider vinegar 80 
Tubercle Bacillus secondary factor. . . 80 

Tuberculosis, to sum up 

Typhus Fever Epidemic 333 

Tuberculosis Fibroid 85 

Tubercle, primary, gradually en- 
larged 81-87 

Tubercle Bacilli found in man and 

animal 86 

Tubercle Bacilli absent 86 

Tuberculosis, definition contrary 86 

theory of believed by few 87 

Tubercle Bacillus, spores of 89 

Tuberculosis artificially produced 90 

due to fermentation 94 



388 



INDEX. 



PAGE 

Tuberculosis due to chemical changes 

in the Blood 94 

cure caused by change of 

belief 104 

" recovery from 105 

Tuberculous matter, absence of indica- 
tive of no pus 285 

Thoma-Zeiss apparatus 295 

Tobacco on slide. . 333 

U 

Unhealthy Blood 67 

Ulcer of Stomach 106 

Uric Acid 146-171 

Unfocused part of picture, the 15 

Unhealthy Blood, photographs of . . . . 67 

Uterus, tubercular 138 

U. S. Government sextant, mirror from 333 



V 

PAGE 

Virchow 183 

Villemin 76-77 

Van Schaick, Dr. G 188 

Van Hoevenberg, Dr 241 

Vitality 320 

Vital Organs 13 

Violin ; 20 

Virchow and Leukemia 20 

Virus Dyscrasia 82 

Violinist 93 

Viscidity in the Blood 186 

Vegetations 205 

W 

Watkins, G. A 9 

Word in regard to illustrations 15 

Wagner 19 

Watson 76-82 

White Blood Cells 273 



3 R 9 "1901 



a 



